Provider Demographics
NPI:1780039032
Name:GISCHEL, JUSTIN WAYNE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WAYNE
Last Name:GISCHEL
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7161
Mailing Address - Country:US
Mailing Address - Phone:850-777-5048
Mailing Address - Fax:
Practice Address - Street 1:1230 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7161
Practice Address - Country:US
Practice Address - Phone:850-777-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013969363LF0000X
MDR186964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F3016686OtherAANP
FL11013969OtherFLORIDA BOARD OF NURSING