Provider Demographics
NPI:1598795049
Name:TURNER, ROBERTA M (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:TURNER
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 1:4400 HWY 20
Mailing Address - Street 2:STE 410
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9735
Mailing Address - Country:US
Mailing Address - Phone:850-897-2000
Mailing Address - Fax:850-897-4359
Practice Address - Street 1:4400 HWY 20
Practice Address - Street 2:STE 410
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9735
Practice Address - Country:US
Practice Address - Phone:850-897-2000
Practice Address - Fax:850-897-4359
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3131382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2679Medicare ID - Type Unspecified
Q17518Medicare UPIN