Healthcare Provider Details

I. General information

NPI: 1760325880
Provider Name (Legal Business Name): ROBERTA ANDREEA ENISOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CLARA AVE APT 1114
PANAMA CITY BEACH FL
32407-2890
US

IV. Provider business mailing address

1105 CLARA AVE APT 1114
PANAMA CITY BEACH FL
32407-2890
US

V. Phone/Fax

Practice location:
  • Phone: 267-593-4924
  • Fax:
Mailing address:
  • Phone: 267-593-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: