Healthcare Provider Details

I. General information

NPI: 1104378306
Provider Name (Legal Business Name): MR. CARLTON ANTHONYSHAWNIE DYKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOVEY ROAD
PENSACOLA FL
32508
US

IV. Provider business mailing address

220 HOVEY RD
PENSACOLA FL
32508
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: