Healthcare Provider Details

I. General information

NPI: 1700904380
Provider Name (Legal Business Name): OKALOOSA HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 HIGHWAY 85 N
NICEVILLE FL
32578-1045
US

IV. Provider business mailing address

2190 HIGHWAY 85 N
NICEVILLE FL
32578-1045
US

V. Phone/Fax

Practice location:
  • Phone: 850-678-4131
  • Fax:
Mailing address:
  • Phone: 850-678-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4052
License Number StateFL

VIII. Authorized Official

Name: MARK DAY
Title or Position: CFO
Credential:
Phone: 850-729-9302