Healthcare Provider Details

I. General information

NPI: 1164105318
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF PENSACOLA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14114 ALABAMA ST
JAY FL
32565-1219
US

IV. Provider business mailing address

9500 S DADELAND BLVD STE 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 850-675-8000
  • Fax: 305-675-3378
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-675-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820