Provider Demographics
NPI:1396272589
Name:SACRED HEART HOSPITAL
Entity type:Organization
Organization Name:SACRED HEART HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:850-416-6272
Mailing Address - Street 1:2669 TULIP HILL RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6787
Mailing Address - Country:US
Mailing Address - Phone:850-375-4760
Mailing Address - Fax:
Practice Address - Street 1:2552 CARMEL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-416-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9172156282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital