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General NPI Number Information
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NPI Number | 1356200315
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Entity Type | Organization
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Legal Business Name | PENSACOLA PEDIATRICS PA
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 5962 BERRYHILL RD
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City | MILTON
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State | FL
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Zip | 32570-4009
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Country | US
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Telephone | 850-983-3700
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Fax | 850-983-0970
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Provider Business Mailing Address
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Address Line | 4951 GRANDE DR
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City | PENSACOLA
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State | FL
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Zip | 32504-8965
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Country | US
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Telephone | 850-473-0100
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Fax | 850-473-0500
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PETER HECKATHORN
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Credential |
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Telephone | 850-473-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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