Healthcare Provider Details

I. General information

NPI: 1538563028
Provider Name (Legal Business Name): DANA BEBBER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA PEACOCK

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 07/21/2022
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 N 12TH AVE
PENSACOLA FL
32504-8916
US

IV. Provider business mailing address

5145 WHEELER WAY
PENSACOLA FL
32526-4438
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-2155
  • Fax:
Mailing address:
  • Phone: 407-212-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberP180866
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024174554
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11003137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: