| Graceland Family Practice | |
|
6470 Tippin Ave Pensacola FL 32504-8143 | |
| (850) 741-2878 | |
| Not Available |
| Full Name | Graceland Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 6470 Tippin Ave, Pensacola, Florida |
| Authorized Official Name and Position | Debra Ann Fickling (PROVIDER) |
| Authorized Official Contact | 8507412878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceland Family Practice 6470 Tippin Ave Pensacola FL 32504-8143 Ph: (850) 741-2878 | Graceland Family Practice 6470 Tippin Ave Pensacola FL 32504-8143 Ph: (850) 741-2878 |
| NPI Number | 1932708617 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 10/22/2020 |
| Medicare PECOS PAC ID | 2466865217 |
|---|---|
| Medicare Enrollment ID | O20210115000999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932708617 | NPI | - | NPPES |
| 1184196669 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Debra A Fickling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184196669 PECOS PAC ID: 2163769589 Enrollment ID: I20190123002995 |
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