Healthcare Provider Details

I. General information

NPI: 1033519780
Provider Name (Legal Business Name): SEAN JOSEPH KIRBY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2014
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S A ST
PENSACOLA FL
32502-5554
US

IV. Provider business mailing address

201 S A ST
PENSACOLA FL
32502-5554
US

V. Phone/Fax

Practice location:
  • Phone: 850-934-7545
  • Fax: 850-934-7972
Mailing address:
  • Phone: 850-934-7545
  • Fax: 850-934-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2279PA
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111243
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2393
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: