# CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1760293872
- **Legal business name:** CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA
- **Authorized official:** JAMES BEN RENFROE MD (PRESIDENT)
- **Authorized official phone:** (850) 932-5055

## Contact information

- **Practice address:** 12815 US HIGHWAY 98 W STE 116, MIRAMAR BEACH, FL 32550-3245
- **Practice address phone:** (850) 932-5055
- **Practice address fax:** (850) 932-1404
- **Mailing address:** PO BOX 280, GULF BREEZE, FL 32562-0280
- **Mailing address phone:** (850) 932-5055
- **Mailing address fax:** (850) 932-1404

## Taxonomy

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

## Other

- **Enumeration date:** 01/17/2025
- **Last updated:** 01/22/2025