Provider Demographics
NPI:1952587461
Name:JANSEN, PAMELA JEANNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEANNE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:500 IKE STEELE RD
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-2428
Mailing Address - Country:US
Mailing Address - Phone:850-639-1312
Mailing Address - Fax:850-639-1305
Practice Address - Street 1:500 IKE STEELE RD
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-2428
Practice Address - Country:US
Practice Address - Phone:850-639-1312
Practice Address - Fax:850-639-1305
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2851152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily