Healthcare Provider Details

I. General information

NPI: 1366814378
Provider Name (Legal Business Name): JOHN-THOMAS CARRINO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1553
US

IV. Provider business mailing address

310 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1553
US

V. Phone/Fax

Practice location:
  • Phone: 850-889-4550
  • Fax: 850-889-4549
Mailing address:
  • Phone: 850-889-4550
  • Fax: 850-889-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: