Healthcare Provider Details

I. General information

NPI: 1235775396
Provider Name (Legal Business Name): PHYSICIAN SERVICES GROUP OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GULF BREEZE PKWY
GULF BREEZE FL
32563-5623
US

IV. Provider business mailing address

3000 GULF BREEZE PKWY
GULF BREEZE FL
32563-5623
US

V. Phone/Fax

Practice location:
  • Phone: 850-324-9633
  • Fax: 850-366-1067
Mailing address:
  • Phone: 850-324-9633
  • Fax: 850-366-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER R DENAPOLES, MD
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 864-303-8650