Provider Demographics
NPI:1518935998
Name:FREEMAN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:FREEMAN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-957-0057
Mailing Address - Street 1:9015 ABB PITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-9305
Mailing Address - Country:US
Mailing Address - Phone:850-957-0057
Mailing Address - Fax:850-957-0067
Practice Address - Street 1:9015 ABB PITMAN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-9305
Practice Address - Country:US
Practice Address - Phone:850-957-0057
Practice Address - Fax:850-957-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1799622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9937OtherBCBS
FLY9937OtherBCBS
FLE4113WMedicare ID - Type Unspecified