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General NPI Number Information
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NPI Number | 1598614695
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Entity Type | Organization
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Legal Business Name | MOMENTUM CLINIC,LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 4400 BAYOU BLVD STE 9
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City | PENSACOLA
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State | FL
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Zip | 32503-1908
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Country | US
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Telephone | 850-289-9839
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 BAYOU BLVD STE 9
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City | PENSACOLA
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State | FL
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Zip | 32503-1908
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Country | US
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Telephone | 850-289-9839
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | IGOR BOGUNOVIC
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Credential | PMHNP-BC,APRN
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Telephone | 850-289-9839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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