Healthcare Provider Details

I. General information

NPI: 1144190604
Provider Name (Legal Business Name): BAPTIST MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY STE 205
GULF BREEZE FL
32561-7808
US

IV. Provider business mailing address

125 BAPTIST WAY STE 6A
PENSACOLA FL
32503-2274
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-6480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON CREECH
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 850-475-3726