Healthcare Provider Details

I. General information

NPI: 1598758815
Provider Name (Legal Business Name): MEDICAL SERVICES OF NORTHWEST FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8974 NAVARRE PKWY
NAVARRE FL
32566-2157
US

IV. Provider business mailing address

8974 NAVARRE PKWY MEDICAL SERVICES OF NORTHWEST FLORIDA INC
NAVARRE FL
32566-2157
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-0400
  • Fax: 850-936-0450
Mailing address:
  • Phone: 850-936-0400
  • Fax: 850-936-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA20707096
License Number StateFL

VIII. Authorized Official

Name: MRS. TIMOTHY M TAYLOR
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 850-936-0400