Provider Demographics
NPI:1548218035
Name:PETTIGREW, JANICE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:PETTIGREW
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 1:2569 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3043
Mailing Address - Country:US
Mailing Address - Phone:850-934-0932
Mailing Address - Fax:850-934-0737
Practice Address - Street 1:2569 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3043
Practice Address - Country:US
Practice Address - Phone:850-934-0932
Practice Address - Fax:850-934-0737
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1833042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8122OtherBCBS
FLY8122OtherBCBS