Healthcare Provider Details

I. General information

NPI: 1164770319
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 VETERANS WAY
PENSACOLA FL
32507-1000
US

IV. Provider business mailing address

790 VETERANS WAY
PENSACOLA FL
32507-1000
US

V. Phone/Fax

Practice location:
  • Phone: 850-912-2233
  • Fax: 850-912-2461
Mailing address:
  • Phone: 850-912-2233
  • Fax: 850-912-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number1046A
License Number StateAL

VIII. Authorized Official

Name: AMY COMERFORD NICHOLS
Title or Position: AUDIOLOGIST
Credential: AU.D., PH.D.
Phone: 850-912-2233