Healthcare Provider Details

I. General information

NPI: 1679589428
Provider Name (Legal Business Name): GULF COAST PHYSICIAN PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 BERRYHILL RD
MILTON FL
32570-8278
US

IV. Provider business mailing address

5907 BERRYHILL RD
MILTON FL
32570-8278
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-9787
  • Fax: 850-626-7512
Mailing address:
  • Phone: 850-623-9787
  • Fax: 850-626-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH FOUNTAIN
Title or Position: PRESIDENT
Credential: DO
Phone: 850-623-9787