Healthcare Provider Details

I. General information

NPI: 1952381675
Provider Name (Legal Business Name): DAVID BRYAN SURBER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HULSE RD
PENSACOLA FL
32508-1089
US

IV. Provider business mailing address

6111 ENTERPRISE DR SUITE 2308
PENSACOLA FL
32505-1623
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-2369
  • Fax:
Mailing address:
  • Phone: 850-452-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00140631
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: