Provider Demographics
NPI:1194374744
Name:TWEEDIE, PAULA LEARY
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LEARY
Last Name:TWEEDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10395 OLD DAIRY LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1300
Mailing Address - Country:US
Mailing Address - Phone:850-478-7388
Mailing Address - Fax:
Practice Address - Street 1:10395 OLD DAIRY LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1300
Practice Address - Country:US
Practice Address - Phone:850-478-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider