MEDICARE: PENSACOLA NEPHROLOGY, PA

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	207RN0300X	Nephrology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF9776	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700829728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSACOLA NEPHROLOGY, PA

Provider Business Mailing Address
First Line	:	PO BOX 11037
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32524-1037
Country	:	US
Telephone Number	:	850-444-7000
Fax Number	:	850-444-7497

Provider Business Practice Location Address
First Line	:	2940 N BLUE ANGEL PKWY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-2925
Country	:	US
Telephone Number	:	850-444-4700
Fax Number	:	850-434-8144

Authorized Official
Title or Position	:	CFO
Name	:	JUSTIN DANSBY
Credential	:
Telephone Number	:	850-444-4700

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/19/2025

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Directions to “PENSACOLA NEPHROLOGY, PA ” Practice Location

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