Provider Demographics
NPI:1679051338
Name:BOHANNON, ALICE SZYMANSKI
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:SZYMANSKI
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MALDONADO DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32561-2242
Mailing Address - Country:US
Mailing Address - Phone:850-207-7527
Mailing Address - Fax:
Practice Address - Street 1:543 FONTAINE ST STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2058
Practice Address - Country:US
Practice Address - Phone:850-474-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1062162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner