Organization · NPI-2

North Okaloosa Clinic Corp

Internal Medicine · Crestview, FL

NPI number1659329852

StatusActive

Last updated in NPPESSep 23, 2024

Details

NPI: 1659329852
Entity type: Organization (NPI-2)
Legal business name: North Okaloosa Clinic Corp
Organization subpart: No
Enumeration date: May 4, 2006
Certification date: Sep 23, 2024
Last updated: Sep 23, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	–	–	Yes
207Q00000X	Family Medicine	–	–
207V00000X	Obstetrics & Gynecology	–	–
207X00000X	Orthopaedic Surgery	–	FL
208000000X	Pediatrics	–	–
208800000X	Urology	–	–
208M00000X	Hospitalist	–	–
363L00000X	Nurse Practitioner	–	–
363LA2200X	Nurse Practitioner, Adult Health	–	–

Practice location

550 Redstone Ave W
Ste. 370
Crestview, FL 32536-6428

Phone 850-682-2209 · Fax 850-682-2528

Mailing address

Po Box 689022
Franklin, TN 37068-9022

Phone 615-628-6038 · Fax 615-628-6832

Authorized official

Kristina Music
Director,provider Enrollment
8778929815

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