North Okaloosa Clinic Corp

NPI #1154990547 in Crestview, Florida

Provider Information

NPI Number: 1154990547
Entity Type: Organization
Organization Name: North Okaloosa Clinic Corp
Primary Specialty: Urology
Enumeration Date: Jun 21, 2021
Last Updated: Mar 18, 2022

Practice Location

Address: 127 E REDSTONE AVE STE B
City: Crestview
State: Florida
ZIP Code: 32539-5356
Phone: (850) 689-8100

Authorized Official

Name: JENNIFER L JACKSON
Title: SR DIR PROV ENROLLMENT & ONBOARDING
Phone: (615) 465-3334

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Urology	208800000X	Primary

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