Basic Information
| Provider Information | |||||||||
| NPI: | 1740426238 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NILSSEN ORTHOPEDICS P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 GULF BREEZE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325617809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509163700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 E BURGESS RD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325047001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504354800 | ||||||||
| FaxNumber: | 8509168629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2009 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | NILSSEN | ||||||||
| AuthorizedOfficialFirstName: | ERIK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8509163700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | ME99816 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.