Organization
EMERALD COAST DIABETES & NUTRITION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA HOWARD-GONZALEZ RD, LD, CDE (OWNER)
(850) 374-7604
Entity
Organization
Contact information
Practice address
115 MIRACLE STRIP PKWY SE UNIT 101, FORT WALTON BEACH, FL 32548-5976
(850) 374-7604
(850) 792-2545
Mailing address
115 MIRACLE STRIP PKWY SE UNIT 101, FORT WALTON BEACH, FL 32548-5976
(850) 374-7604
(850) 792-2545
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
ND3885
FL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1J0TM
BCBS
FL
01
—
ND3885
FLORIDA LICENSE
FL
Enumeration date
07/02/2017
Last updated
09/13/2022
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