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General NPI Number Information
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NPI Number | 1053313312
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Entity Type | Individual
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Provider Name | RICHARD O NENSTIEL PAC
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 1040 GULF BREEZE PKWY STE 200
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City | GULF BREEZE
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State | FL
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Zip | 32561-7808
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Country | US
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Telephone | 850-916-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 6701 AIRPORT BLVD SUITE D146
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City | MOBILE
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State | AL
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Zip | 36608
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Country | US
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Telephone | 251-633-5155
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Fax | 251-633-5125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-143
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9115249
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA-143
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9115249
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License Number State | FL
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