| Doctor Name: | RUSTIN G SORENSEN |
| NPI Number: | 1164433827 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA9101453 |
| Business Practice Address: | 1950 Bluewater Blvd Suite 100 Niceville, FL - 32578 |
| Business Phone Number: | 8508978081 |
| Business Fax Number: | 8508973846 |
| Mailing Address: | 1950 Bluewater Blvd, Suite 100 NICEVILLE |
| State: | FL |
| Postal Code: | 32578 |
| Phone Number: | 8508978081 |
| Fax Number: | 8508973846 |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 01/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA9101453 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |