Healthcare Provider Details

I. General information

NPI: 1518969765
Provider Name (Legal Business Name): PENSACOLA NEPHROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CREIGHTON RD STE 1
PENSACOLA FL
32504-7152
US

IV. Provider business mailing address

PO BOX 11037
PENSACOLA FL
32524-1037
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-4700
  • Fax: 850-434-8144
Mailing address:
  • Phone: 850-444-4700
  • Fax: 850-444-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DANSBY
Title or Position: CFO
Credential:
Phone: 850-444-4700