Healthcare Provider Details

I. General information

NPI: 1396865556
Provider Name (Legal Business Name): EMERALD COAST URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12598 HIGHWAY 98 SUITE 101
DESTIN FL
32552
US

IV. Provider business mailing address

4520 JAMESTOWN AVE STE 3
BATON ROUGE LA
70808-3214
US

V. Phone/Fax

Practice location:
  • Phone: 850-654-8878
  • Fax: 850-654-8840
Mailing address:
  • Phone: 225-706-3033
  • Fax: 225-218-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY PAUL NICHOLS
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 225-933-2044