Provider Demographics
NPI:1598487050
Name:PRIMARY CARE & FUNCTIONAL MEDICINE CONSULTANTS LLC
Entity Type:Organization
Organization Name:PRIMARY CARE & FUNCTIONAL MEDICINE CONSULTANTS LLC
Other - Org Name:FUNCTIONAL MEDICINE & HOLISTIC WELLNESS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:850-215-5830
Mailing Address - Street 1:508 AIRPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4025
Mailing Address - Country:US
Mailing Address - Phone:850-215-5830
Mailing Address - Fax:850-353-7006
Practice Address - Street 1:508 AIRPORT RD STE D
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4025
Practice Address - Country:US
Practice Address - Phone:850-890-5559
Practice Address - Fax:850-353-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty