Provider Demographics
NPI:1457579435
Name:NILSSEN, ERIK CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:CHRISTIAN
Last Name:NILSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:850-916-3710
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:850-916-3710
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12345678207X00000X
FLME99816207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05120OtherBLUE CROSS BLUE SHIELD
AL592-05518OtherBLUE CROSS BLUE SHIELD
AL592-05518OtherBLUE CROSS BLUE SHIELD
FLBP020ZMedicare PIN