Healthcare Provider Details

I. General information

NPI: 1790960508
Provider Name (Legal Business Name): PENSACOLA PODIATRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 N DAVIS HWY STE 1
PENSACOLA FL
32504-6967
US

IV. Provider business mailing address

6160 N DAVIS HWY STE 1
PENSACOLA FL
32504-6967
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-2805
  • Fax: 850-476-3010
Mailing address:
  • Phone: 850-476-2805
  • Fax: 850-476-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: VALERIE BURBANK
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-476-2805