Provider Demographics
NPI:1063535151
Name:BRINSON, SHELBY E (PA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:E
Last Name:BRINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:E
Other - Last Name:BRINSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4457 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2601
Mailing Address - Country:US
Mailing Address - Phone:850-226-6801
Mailing Address - Fax:
Practice Address - Street 1:1851 SAINT MARY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1053
Practice Address - Country:US
Practice Address - Phone:850-226-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104115363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104115OtherPA LICENSE