Provider Demographics
NPI:1740552439
Name:PEARSON, BOBBIE SUE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:SUE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 LEGENDARY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5347
Mailing Address - Country:US
Mailing Address - Phone:850-424-7320
Mailing Address - Fax:833-807-0111
Practice Address - Street 1:4476 LEGENDARY DR # 101
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5375
Practice Address - Country:US
Practice Address - Phone:850-424-7320
Practice Address - Fax:850-424-7322
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR798707363LF0000X
FLAPRN11007880363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily