Provider Demographics
NPI:1740426238
Name:NILSSEN ORTHOPEDICS P A
Entity Type:Organization
Organization Name:NILSSEN ORTHOPEDICS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:C
Authorized Official - Last Name:NILSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-916-3700
Mailing Address - Street 1:1040 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7809
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:
Practice Address - Street 1:825 E BURGESS RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7001
Practice Address - Country:US
Practice Address - Phone:850-435-4800
Practice Address - Fax:850-916-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99816207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6245530001Medicare NSC
FLBP019AMedicare PIN