Healthcare Provider Details

I. General information

NPI: 1467226753
Provider Name (Legal Business Name): ETHAN DANIEL ZERPA-BLANCO DO, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HULSE RD BLDG 32508
PENSACOLA FL
32508-1092
US

IV. Provider business mailing address

340 HULSE RD BLDG 32508
PENSACOLA FL
32508-1092
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-2933
  • Fax:
Mailing address:
  • Phone: 850-452-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: