Healthcare Provider Details

I. General information

NPI: 1760309066
Provider Name (Legal Business Name): ANDREW DE COTIS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BEAL PKWY NW
FORT WALTON BEACH FL
32548-4358
US

IV. Provider business mailing address

131 BEAL PKWY NW
FORT WALTON BEACH FL
32548-4358
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-8558
  • Fax: 850-243-8558
Mailing address:
  • Phone: 850-243-8558
  • Fax: 850-243-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: