Healthcare Provider Details

I. General information

NPI: 1477539914
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF THE GULF COAST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/11/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8121
  • Fax: 850-474-8096
Mailing address:
  • Phone: 850-474-8121
  • Fax: 850-474-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GARY SMITH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 850-474-8121