# CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053392233
- **Authorized official:** MR. JAMES BEN RENFROE M.D. (OWNER)
- **Authorized official phone:** (850) 932-5055

## Contact information

- **Practice address:** 400 GULF BREEZE PKWY, SUITE 300, GULF BREEZE, FL 32561-4495
- **Practice address phone:** (850) 932-5055
- **Practice address fax:** (850) 932-1401
- **Mailing address:** PO BOX 280, GULF BREEZE, FL 32562-0280
- **Mailing address phone:** (850) 932-5055
- **Mailing address fax:** (850) 932-1401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084N0402X | Neurology with Special Qualifications in Child Neurology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2005
- **Last updated:** 01/20/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 257889100 | — | FL |
| 05 | — | 529918930 | — | AL |