Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | OS11646 | FL |
NPI | 1124255310 |
---|---|
Provider Name | Andrew Dominick Bianchi |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 15/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0063415-00 | (05) | FL |
14KQ8 | BCBS FL (01) | FL |