Healthcare Provider Details

I. General information

NPI: 1386077287
Provider Name (Legal Business Name): NEUROMICROSPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S A ST
PENSACOLA FL
32502-5554
US

IV. Provider business mailing address

201 S A ST
PENSACOLA FL
32502-5554
US

V. Phone/Fax

Practice location:
  • Phone: 850-934-7545
  • Fax: 850-934-7972
Mailing address:
  • Phone: 850-934-7545
  • Fax: 850-934-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDIE CAPERTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-934-7545