Provider Demographics
NPI:1295215911
Name:MEHMEDOVIC, SELMA (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:
Last Name:MEHMEDOVIC
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ASSANA CT
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-9305
Mailing Address - Country:US
Mailing Address - Phone:314-387-1847
Mailing Address - Fax:
Practice Address - Street 1:54 ASSANA CT
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-9305
Practice Address - Country:US
Practice Address - Phone:314-387-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9484886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner