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Organization
SOUTHERN PSYCHIATRY LLC
Active
Organization
SOUTHERN PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE MCCORMACK APRN (OWNER)
(850) 687-0887
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, CRESTVIEW, FL 32539-7355
(850) 687-0887
Mailing address
201 N BLUE HERON DR, SANTA ROSA BEACH, FL 32459-3039
(850) 687-0887
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
02/11/2019
Last updated
12/15/2022
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