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General NPI Number Information
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NPI Number | 1548204357
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Entity Type | Organization
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Legal Business Name | PENSACOLA NEPHROLOGY PA
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 6001 INDUSTRIAL BLVD
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City | CENTURY
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State | FL
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Zip | 32535-3312
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Country | US
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Telephone | 850-444-4700
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Fax | 850-444-9766
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Provider Business Mailing Address
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Address Line | PO BOX 11037
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City | PENSACOLA
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State | FL
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Zip | 32524-1037
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Country | US
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Telephone | 850-444-7000
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Fax | 850-434-8144
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | SAVANNA VAN BRUSSEL
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Credential |
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Telephone | 850-444-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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