MEDICARE: PENSACOLA NEPHROLOGY, PA

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	CF9776	OTHER		RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0358	OTHER	FL	MED3000/HEALTH 1ST NETWOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	99659	OTHER	FL	BCBS OF FLORIDA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1871535955
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	:	850-444-4700
Fax Number	:	850-444-7497

Provider Business Practice Location Address
First Line	:	319 GREEN ACRES RD STE 103
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1170
Country	:	US
Telephone Number	:	850-862-2385
Fax Number	:	850-862-0482

Authorized Official
Title or Position	:	CFO
Name	:	JUSTIN DANSBY
Credential	:
Telephone Number	:	850-444-7000

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/19/2025