Provider Demographics
NPI:1447930656
Name:PENSACOLA NEPHROLOGY, PA
Entity type:Organization
Organization Name:PENSACOLA NEPHROLOGY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-444-4700
Mailing Address - Street 1:PO BOX 11037
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1037
Mailing Address - Country:US
Mailing Address - Phone:850-444-4700
Mailing Address - Fax:
Practice Address - Street 1:5976 BERRYHILL RD STE A
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4009
Practice Address - Country:US
Practice Address - Phone:850-623-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENSACOLA NEPHROLOGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-21
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256870500Medicaid
FL256870501Medicaid
FL256870502Medicaid
FL256870504Medicaid
FL256870503Medicaid