Organization
EMERALD COAST DERMATOLOGY & SKIN SURGERY CENTER P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLIAN OWENS (CREDENTIALING AND CONTRACTING)
(850) 689-1740
Entity
Organization
Contact information
Practice address
350 REDSTONE AVE W, CRESTVIEW, FL 32536-6433
(850) 689-1740
(850) 682-6652
Mailing address
350 REDSTONE AVE W, CRESTVIEW, FL 32536-6433
(850) 689-1740
(850) 682-6652
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0061435
FL
Other
Enumeration date
09/20/2005
Last updated
01/20/2026
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