SOUTHERN BREEZE HEALTHCARE (NPI# 1376028563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376028563 |
| Entity Type | Organization |
| Organization Name | SOUTHERN BREEZE HEALTHCARE |
| Practice Address |
4556 E Hwy 20 Suite 105 Niceville FL 32578 |
| Practice Telephone | 9109881326 |
| Mailing Telephone | 9109881326 |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2018-10-03 |
| Authorized Official Name | GARY BULLARD (PHYSICIAN ASSISTANT) |
| Authorized Official Telephone | 9109881326 |
| Authorized Official Credential | P.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTHERN BREEZE HEALTHCARE | 4566 E Highway 20, Niceville, FL 32578-8838 |
| Street Address |
4556 E HWY 20 SUITE 105 |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1326326869 | Alternative Living, Inc. | Assisted Living Facility | 1053 John Sims Parkway, Niceville, FL 32578 | 2011-08-02 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598238263 | April R Pretz | Family Medicine | 812 Saint Kitts Cv, Niceville, FL 32578-3816 | 2019-01-06 |
| 1316472368 | Terence B Mitchell Md Inc | Family Medicine | 2600 Partin Dr N Ste 300, Suite 330, Niceville, FL 32578-1543 | 2017-04-27 |
| 1184036725 | Julie Staats Do Family Medicine Pa | Family Medicine | 2600 Partin Dr N Ste 120, Niceville, FL 32578-1543 | 2014-06-02 |
| 1942488432 | Southland Emergency Medical Services of Fl Pl | Family Medicine | 1706 15th St, Niceville, FL 32578-3677 | 2008-02-06 |
| 1184758526 | Pat Thomas Tidwell | Family Medicine | 4400 E Highway 20 Ste 203, Niceville, FL 32578-7700 | 2007-03-16 |
| 1881752616 | Eduardo Luis Gonzalez | Family Medicine | 4400 E Highway 20 Ste 209, Niceville, FL 32578-7700 | 2006-12-05 |
| 1124125505 | Steven Lester Clark | Family Medicine | 4586 E Highway 20, Suite B, Niceville, FL 32578-9724 | 2006-09-20 |
| 1861456592 | Terence Burrell Mitchell | Family Medicine | 2600 Partin Dr N Ste 330, Niceville, FL 32578-1542 | 2006-04-12 |
| 1679546675 | Swati Nigam Grover | Family Medicine | 1065 Napa Way, Niceville, FL 32578-3960 | 2006-02-09 |
| 1629048442 | Alec H Schmidt | Family Medicine | 1003 W College Blvd, Ste 3, Niceville, FL 32578 | 2006-01-24 |
| Find all providers in NICEVILLE | ||||
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| 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.