NPIMap

Organization Active NPI

Dynamic Pain & Wellness LLC

  • Physician Assistant
  • Pensacola, FL
National Provider Identifier
1922938174
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
DYNAMIC PAIN & WELLNESS LLC
Practice address
5111 N 12TH Ave
Pensacola, FL 32504-8918
Phone
(850) 226-6801
Fax
(877) 413-5104
NPI assigned
May 20, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Trista Elliott
Title
Credentialing
Phone
(850) 226-6801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

5111 N 12TH Ave
Pensacola, FL 32504-8918

Mailing address

930 Mar Walt Drive Ste C
Fort Walton Beach, FL 32547-6706
Phone (850) 226-6801

National Provider Directory

National Provider Directory
Tax ID family
Dynamic Pain Wellness LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1779235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779235200000",
    "number": "1922938174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DRIVE STE C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 N 12TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048918",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PAIN & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-20",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "TRISTA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "850-226-6801"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.