OrganizationMma WellnessNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2428 Jenks Ave, Panama City, FL 32405-4304(850) 788-3120PECOS EnrollmentBased on the most recent information from CMS, provider Mma Wellness does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1053892620Provider TypeOrganizationFull NameMma WellnessSubpartYesEnumeration Date8/22/2018Last Updated5/20/2020Contact InformationPractice LocationPractice Address2428 Jenks Ave, Panama City, FL 32405-4304Phone(850) 788-3120Fax(850) 788-3125Mailing LocationMailing Address1417 Maine Ave, Lynn Haven, FL 32444-2129Phone(850) 788-3120FaxUnlisted FaxAuthorized OfficialNameAndrews, Mary Margaret (President)Phone(850) 814-6562Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP9266378Florida