MEDICARE: RICHARD O NENSTIEL PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-143	AL
2	363AM0700X	Medical Physician Assistant	PA9115249	FL
3	363AS0400X	Surgical Physician Assistant	PA-143	AL
4	363AS0400X	Surgical Physician Assistant	PA9115249	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51540426	OTHER	AL	BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053313312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD O NENSTIEL PAC

Provider Business Mailing Address
First Line	:	6701 AIRPORT BLVD
Second Line	:	SUITE D146
City	:	MOBILE
State	:	AL
Zip	:	36608
Country	:	US
Telephone Number	:	251-633-5155
Fax Number	:	251-633-5125

Provider Business Practice Location Address
First Line	:	1040 GULF BREEZE PKWY STE 200
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-7808
Country	:	US
Telephone Number	:	850-916-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/13/2023

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Directions to “ RICHARD O NENSTIEL PAC” Practice Location

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