# NORTHWEST FLORIDA HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chipley Medical Group-MH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972311785
- **Authorized official:** STEVEN LISENBY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (850) 415-8107

## Contact information

- **Practice address:** 1376 BRICKYARD RD, CHIPLEY, FL 32428-6391
- **Practice address phone:** (850) 638-0552
- **Mailing address:** 1360 BRICKYARD RD, CHIPLEY, FL 32428-6303
- **Mailing address phone:** (850) 638-1610
- **Mailing address fax:** (850) 638-0662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2024
- **Last updated:** 12/26/2024