EMERALD WATERS MEDICAL CLINIC LLC (NPI# 1306192216) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306192216 |
| Entity Type | Organization |
| Organization Name | EMERALD WATERS MEDICAL CLINIC LLC |
| Practice Address |
1005 College Blvd W Suite B Niceville FL 32578-1060 |
| Practice Telephone | 8502796815 |
| Practice Fax Number | 8502796817 |
| Mailing Telephone | 8502796815 |
| Mailing Fax Number | 8502796817 |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2012-11-05 |
| Authorized Official Name | MS. MAURICIA STANTON (OWNER/PROVIDER) |
| Authorized Official Telephone | 8505826059 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
ARNP3114742 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
ARNP3114742 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EMERALD WATERS MEDICAL CLINIC LLC | 1005 College Blvd W Ste B, Niceville, FL 32578-1060 |
| Street Address |
1005 COLLEGE BLVD W SUITE B |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-1060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326013822 | Sushil Kumar Asthana | Surgery | 1005 College Blvd W, Suite C, Niceville, FL 32578-1053 | 2006-02-20 |
| 1134422389 | Mark E. Schroeder M.d.pa | Internal Medicine | 1005 College Blvd W, Suite C, Niceville, FL 32578-1053 | 2010-12-09 |
| 1548286552 | Abc Pediatrics | Pediatrics | 1005 College Blvd W, Suite B, Niceville, FL 32578-1053 | 2006-07-14 |
| 1013944552 | Hygeia Medical Group Pa | Surgery | 1005 College Blvd W, Suite C, Niceville, FL 32578-1053 | 2006-06-28 |
| 1932174091 | Mark Edward Schroeder | Internal Medicine | 1005 College Blvd W, Suite C, Niceville, FL 32578-1053 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 363LW0102X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Women's Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| 1578055976 | Sydney Morgan Howk | Nurse Practitioner | 4554 E Highway 20, Niceville, FL 32578-9755 | 2018-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861005464 | Sharon Resto | Nurse Practitioner | 16206 Breckinmore Ln, Tampa, FL 33625-1004 | 2020-08-25 |
| 1346863552 | Danielle Selig Jaeger | Nurse Practitioner | 27 Flowertree Dr, Ormond Beach, FL 32174-3091 | 2020-05-21 |
| 1568096550 | Denise Nicely | Nurse Practitioner | 5100 Station Way, Sarasota, FL 34233-3221 | 2020-02-27 |
| 1104450592 | Kionna Sadie Pitts | Nurse Practitioner | 2902 N Armenia Ave Ste 100, Tampa, FL 33607-1661 | 2020-02-25 |
| 1720610090 | Patricia Rivero | Nurse Practitioner | 445 Woodcrest Rd, Key Biscayne, FL 33149-1838 | 2020-02-05 |
| 1215567524 | Kristina Chardon | Nurse Practitioner | 11500 University Blvd Ste B, Orlando, FL 32817-2197 | 2020-01-26 |
| 1962043554 | Marcel Bernadette Nagel | Nurse Practitioner | 1523 Ashlee Branch Way, Saint Johns, FL 32259-1923 | 2019-10-04 |
| 1336798412 | Vicky Arlene Smith | Nurse Practitioner | 501 Pointe Allyson Way, Orlando, FL 32825-5973 | 2019-09-10 |
| 1003476011 | Angela Marie Bumpus | Nurse Practitioner | 9121 Lantern Oak Way, Land O Lakes, FL 34638-2607 | 2019-06-20 |
| 1396301230 | Mary Elizabeth Buie | Nurse Practitioner | 5457 Baldwin Park St, Orlando, FL 32814-6749 | 2019-05-16 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EMERALD WATERS MEDICAL CLINIC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.