Provider Demographics
NPI:1235112939
Name:FRANTZ, PENNY R (ARNP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:R
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914C MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6706
Mailing Address - Country:US
Mailing Address - Phone:850-863-3199
Mailing Address - Fax:850-863-3196
Practice Address - Street 1:914C MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6706
Practice Address - Country:US
Practice Address - Phone:850-863-3199
Practice Address - Fax:850-863-3196
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1549362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00114955OtherRAILROAD MEDICARE
FLP00114955OtherRAILROAD MEDICARE
FLE3711ZMedicare ID - Type Unspecified