Healthcare Provider Details

I. General information

NPI: 1841236726
Provider Name (Legal Business Name): COMFORT CARE MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 N DAVIS HWY STE 1-C
PENSACOLA FL
32503-2720
US

IV. Provider business mailing address

4511 N DAVIS HWY STE 1-C
PENSACOLA FL
32503-2720
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-9088
  • Fax: 850-476-9902
Mailing address:
  • Phone: 850-476-9088
  • Fax: 850-476-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN CRUMLISH
Title or Position: SECRETARY/TREASURER
Credential: PA-C
Phone: 850-476-9088