Healthcare Provider Details

I. General information

NPI: 1477738896
Provider Name (Legal Business Name): NORTH OKALOOSA CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 REDSTONE AVE W STE. 370
CRESTVIEW FL
32536-6428
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-2209
  • Fax: 850-682-2528
Mailing address:
  • Phone: 615-465-7626
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 615-465-3334