Provider Demographics
NPI:1114208261
Name:MORELAND, TOBIAS J (PA-C)
Entity Type:Individual
Prefix:
First Name:TOBIAS
Middle Name:J
Last Name:MORELAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:TOBY
Other - Middle Name:
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-9025
Mailing Address - Fax:850-494-7855
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE 325A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-475-9025
Practice Address - Fax:850-494-7855
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant