Provider Demographics
NPI:1982223715
Name:PETRUS-PURSER, PAMELA (AP, LAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PETRUS-PURSER
Suffix:
Gender:F
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7287 NAVARRE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7307
Mailing Address - Country:US
Mailing Address - Phone:850-889-2908
Mailing Address - Fax:
Practice Address - Street 1:7287 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7307
Practice Address - Country:US
Practice Address - Phone:850-889-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3992171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist