Provider Demographics
NPI:1801175310
Name:MURPHY, PAMELA NICOLE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:NICOLE
Last Name:MURPHY
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 1:6965 PIAZZA GRANDE AVE
Mailing Address - Street 2:SUITE 311 UNIT 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8781
Mailing Address - Country:US
Mailing Address - Phone:919-771-4370
Mailing Address - Fax:877-220-5749
Practice Address - Street 1:6965 PIAZZA GRANDE AVE
Practice Address - Street 2:SUITE 311 UNIT 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8781
Practice Address - Country:US
Practice Address - Phone:919-771-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004217101Medicaid