Healthcare Provider Details

I. General information

NPI: 1497616999
Provider Name (Legal Business Name): JENNIFER REID FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER OGORMAN

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MAR WALT DR
FORT WALTON BEACH FL
32547-6707
US

IV. Provider business mailing address

71 MARY ESTHER BLVD
MARY ESTHER FL
32569-1967
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-8100
  • Fax: 833-916-2239
Mailing address:
  • Phone: 866-389-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: