Unknown Individual – Physician Assistant, NPI 1356343537
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
36474A Emerald Coast Pkwy Ste 1102
Destin, FL 325413706
Phone: (850) 862-2385
Fax: (850) 862-0482
Type: Location
Creighton Road, Gull Point, Pensacola, Escambia County, Florida, 32504, United States
PENSACOLA, FL 325047152
Phone: (850) 444-4700
Fax: (850) 444-7497
Type: Mailing
6001 Industrial Blvd
Century, FL 325353312
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
1717 N E St Ste 403
Pensacola, FL 325016334
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
2940 N Blue Angel Pkwy
Pensacola, FL 325062925
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
5149 N 9th Ave Ste G35
Pensacola, FL 325048733
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
4583 Watkins St
Pace, FL 325712511
Phone: (850) 889-4152
Fax: (850) 623-3938
Type: Location
4304 Lancaster Dr
Niceville, FL 325784563
Phone: (850) 862-2385
Fax: (850) 862-0482
Type: Location
8880 Navarre Pkwy Ste 101
Navarre, FL 325663613
Phone: (850) 862-2385
Fax: (850) 862-0482
Type: Location
5934 Berryhill Medical Park Dr # 1
Milton, FL 32570
Phone: (850) 623-4771
Fax: (850) 623-4771
Type: Location
14114 Alabama St
Jay, FL 325651219
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
1118 Gulf Breeze Pkwy Ste 200
Gulf Breeze, FL 325617806
Phone: (850) 444-4700
Fax: (850) 434-8144
Type: Location
319 Green Acres Rd Ste 103
Fort Walton Beach, FL 325471170
Phone: (850) 862-2385
Fax: (850) 862-0482
Type: Location
4415 US Highway 331 S
Defuniak Springs, FL 324356307
Phone: (850) 398-6606
Fax: (850) 398-6424
Type: Location
221 E Redstone Ave
Crestview, FL 325395373
Phone: (850) 398-6606
Fax: (850) 398-6424
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32541)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | FL | 90966 | Home dialysis services per month, patient 20 years of age or older | 163 | 36 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nephrology, Internal Medicine | FL | |
| Nurse Practitioner | FL | |
| - | FL | |
| - | FL | |
| - | FL | |
| - | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Internal Medicine, Nephrology | FL | |
| Nurse Practitioner | FL |
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