Healthcare Provider Details

I. General information

NPI: 1841840980
Provider Name (Legal Business Name): DELANTA MCCALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0003
US

IV. Provider business mailing address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0003
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6181
  • Fax:
Mailing address:
  • Phone: 850-505-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024182173
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: