Provider Demographics
NPI:1104911783
Name:VINSON, BILLY SCOTT (CRNA)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:SCOTT
Last Name:VINSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:B
Other - Middle Name:SCOTT
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:4900 BAYOU BOULEVARD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4810 NORTH DAVIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-474-8988
Practice Address - Fax:850-476-5312
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3189022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2215OtherBCBS OF FLORIDA
P00252451OtherRAILROAD MEDICARE
FLG2215OtherBCBS OF FLORIDA