Healthcare Provider Details

I. General information

NPI: 1063535151
Provider Name (Legal Business Name): SHELBY E BRINSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHELBY E BRINSON JR. PA

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 SAINT MARY AVE
PENSACOLA FL
32501-1053
US

IV. Provider business mailing address

4457 BAYOU BLVD
PENSACOLA FL
32503-2601
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax:
Mailing address:
  • Phone: 850-226-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104115
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: