Individual
RUSTIN G SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1950 BLUEWATER BLVD, SUITE 100, NICEVILLE, FL 32578
(850) 897-8081
(850) 897-3846
Mailing address
1950 BLUEWATER BLVD, SUITE 100, NICEVILLE, FL 32578
(850) 897-8081
(850) 897-3846
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9101453
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970023871
RRMC
FL
Enumeration date
08/10/2006
Last updated
01/27/2010
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