Provider Demographics
NPI:1033519780
Name:KIRBY, SEAN JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:JOSEPH
Last Name:KIRBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 UNIVERSITY PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5485
Mailing Address - Country:US
Mailing Address - Phone:850-934-7545
Mailing Address - Fax:850-934-7972
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 309
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:850-934-7545
Practice Address - Fax:850-934-7972
Is Sole Proprietor?:No
Enumeration Date:2014-08-31
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2393363A00000X, 363A00000X
SC2279PA363AS0400X
FLPA9111243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2279PAMedicaid
SC2279PAMedicaid