Organization
NORTH OKALOOSA CLINIC CORP
Active
Organization
NORTH OKALOOSA CLINIC CORP
Active
Other names
North Okaloosa Physician Group Pulmono, North Okaloosa Clinic Corp
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
550 REDSTONE AVE W STE 490, CRESTVIEW, FL 32536-6457
(850) 689-8321
(850) 689-8322
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273693405
—
FL
Enumeration date
06/23/2021
Last updated
03/18/2022
Update your record
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