White-wilson Medical Center | |
1005 Mar Walt Dr Administration Fort Walton Beach FL 32547-6707 | |
(850) 863-8131 | |
(850) 863-4152 |
Full Name | White-wilson Medical Center |
---|---|
Speciality | Clinic/Center |
Location | 1005 Mar Walt Dr, Fort Walton Beach, Florida |
Authorized Official Name and Position | Kathy A Leeper (MEDICAL STAFF COORDINATOR) |
Authorized Official Contact | 8508638150 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
White-wilson Medical Center 1005 Mar Walt Dr Administration Fort Walton Beach FL 32547-6707 Ph: (850) 863-8131 | White-wilson Medical Center 1005 Mar Walt Dr Administration Fort Walton Beach FL 32547-6707 Ph: (850) 863-8131 |
NPI Number | 1467437277 |
---|---|
Provider Enumeration Date | 12/14/2005 |
Last Update Date | 11/15/2019 |
Medicare PECOS PAC ID | 4082510607 |
---|---|
Medicare Enrollment ID | O20031212000140 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467437277 | NPI | - | NPPES |
059722800 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Sara Ann Rushing |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1295793586 PECOS PAC ID: 8820981780 Enrollment ID: I20040204000771 |
Provider Name | Douglas Winston Rigby |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1265417166 PECOS PAC ID: 6800792433 Enrollment ID: I20040528001112 |
Provider Name | Ajay K Goyal |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1689786774 PECOS PAC ID: 2860442100 Enrollment ID: I20050126000704 |
Provider Name | John Edwin Mills |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1437134301 PECOS PAC ID: 1052345212 Enrollment ID: I20050927000291 |
Provider Name | Paul Tartarilla |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285610899 PECOS PAC ID: 4183637317 Enrollment ID: I20060711000070 |
Provider Name | Randall Louis Mckissack |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1487639621 PECOS PAC ID: 3476595364 Enrollment ID: I20061114000035 |
Provider Name | Fred Earhart Aubert |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1952307878 PECOS PAC ID: 1355240656 Enrollment ID: I20061120000184 |
Provider Name | Timothy David Skinner |
---|---|
Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1043433022 PECOS PAC ID: 7113027673 Enrollment ID: I20070712000547 |
Provider Name | John C Chaney |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1346270592 PECOS PAC ID: 8426149923 Enrollment ID: I20070814000012 |
Provider Name | John Christofer Dali |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1023083177 PECOS PAC ID: 3870683816 Enrollment ID: I20071214000259 |
Provider Name | Norman Bull Clinkscales |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1588640759 PECOS PAC ID: 5496720666 Enrollment ID: I20080730000424 |
Provider Name | Christopher Dale Abrasley |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1760505341 PECOS PAC ID: 0840364824 Enrollment ID: I20080808000680 |
Provider Name | Christopher Brian Cave |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1730169848 PECOS PAC ID: 2062550171 Enrollment ID: I20091111000366 |
Provider Name | David William Burkland |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1467437616 PECOS PAC ID: 3072653864 Enrollment ID: I20091230000149 |
Provider Name | Karl Walter Metz |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1134104169 PECOS PAC ID: 1759461866 Enrollment ID: I20091230000221 |
Provider Name | Christopher Michael Hansen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306821293 PECOS PAC ID: 4880735422 Enrollment ID: I20100105000514 |
Provider Name | Reed Leighton Harned |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1265417398 PECOS PAC ID: 6709927353 Enrollment ID: I20100105000608 |
Provider Name | Melissa Josephine Fischer |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1942285036 PECOS PAC ID: 0749321727 Enrollment ID: I20100113000358 |
Provider Name | Gilberto Luis Vigo |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790760502 PECOS PAC ID: 1153462130 Enrollment ID: I20100113000405 |
Provider Name | Andrew Menhuang Yang |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1679558852 PECOS PAC ID: 0840331708 Enrollment ID: I20100114000231 |
Provider Name | Charles Mark Riggenbach |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1346225240 PECOS PAC ID: 9234271198 Enrollment ID: I20100115000344 |
Provider Name | Vergil Kenneth Brown |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1871578955 PECOS PAC ID: 2062554686 Enrollment ID: I20100120000663 |
Provider Name | Vicente Arturo Mendez |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1740257773 PECOS PAC ID: 8325015670 Enrollment ID: I20100309000462 |
Provider Name | Vincent T Jones |
---|---|
Provider Type | Practitioner - Diagnostic Radiology |
Provider Identifiers | NPI Number: 1285628743 PECOS PAC ID: 6507995065 Enrollment ID: I20100521000820 |
Provider Name | Charles F Nardi |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1437141199 PECOS PAC ID: 0840329710 Enrollment ID: I20100602000713 |
Provider Name | Krishan Nagda |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1033182027 PECOS PAC ID: 7416855671 Enrollment ID: I20100629000409 |
Provider Name | Pamela Y Lee |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467763326 PECOS PAC ID: 5092846162 Enrollment ID: I20100706000795 |
Provider Name | Rodney E Powell |
---|---|
Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
Provider Identifiers | NPI Number: 1821063959 PECOS PAC ID: 5395878292 Enrollment ID: I20100729000134 |
Provider Name | Angel Arturo Nunez |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1366543456 PECOS PAC ID: 9739374901 Enrollment ID: I20101119000295 |
Provider Name | Richard Charles Reno |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1295849438 PECOS PAC ID: 4981877263 Enrollment ID: I20111102000095 |
Provider Name | Richard D Freier |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1568625804 PECOS PAC ID: 9234304007 Enrollment ID: I20111206000166 |
Provider Name | Chinh Vien Van |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124336839 PECOS PAC ID: 0042468548 Enrollment ID: I20120906000769 |
Provider Name | Kirk Francis Garcia-rios |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1033341821 PECOS PAC ID: 9335392166 Enrollment ID: I20130103000441 |
Provider Name | Yuan Wang |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1407016579 PECOS PAC ID: 2264506211 Enrollment ID: I20130307000179 |
Provider Name | Robert Franklin Shelton |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1871578781 PECOS PAC ID: 6103906219 Enrollment ID: I20130701000362 |
Provider Name | Evan Roy Meeks |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1376533869 PECOS PAC ID: 7618118779 Enrollment ID: I20130801000311 |
Provider Name | Kurt Christian Eppley |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962601815 PECOS PAC ID: 5597927756 Enrollment ID: I20131023001033 |
Provider Name | Clarence Michael Hutto |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245461508 PECOS PAC ID: 7012145907 Enrollment ID: I20140123000846 |
Provider Name | Deborah Lynn Gilmore |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104248251 PECOS PAC ID: 5890924831 Enrollment ID: I20140214001107 |
Provider Name | Lindsey A Mann-badyrka |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457766214 PECOS PAC ID: 2163743386 Enrollment ID: I20150530000049 |
Provider Name | Philip Frank Jessen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871977173 PECOS PAC ID: 4587970355 Enrollment ID: I20150825004700 |
Provider Name | Mervin Manuel |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1215070396 PECOS PAC ID: 4789777939 Enrollment ID: I20151002001083 |
Provider Name | Ana May Magdalen Pascual Manuel |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548498512 PECOS PAC ID: 0345497186 Enrollment ID: I20151019000525 |
Provider Name | William Elsworth Gross |
---|---|
Provider Type | Practitioner - Otolaryngology |
Provider Identifiers | NPI Number: 1114916756 PECOS PAC ID: 4284823386 Enrollment ID: I20151203001554 |
Provider Name | Charles Bradley Arbogast |
---|---|
Provider Type | Practitioner - Nephrology |
Provider Identifiers | NPI Number: 1740269448 PECOS PAC ID: 3971742214 Enrollment ID: I20151222002423 |
Provider Name | Walter Rustmann |
---|---|
Provider Type | Practitioner - Critical Care (intensivists) |
Provider Identifiers | NPI Number: 1235116054 PECOS PAC ID: 0042251506 Enrollment ID: I20160209002010 |
Provider Name | Luke Simon Olivera Yuhico |
---|---|
Provider Type | Practitioner - Critical Care (intensivists) |
Provider Identifiers | NPI Number: 1740414465 PECOS PAC ID: 6608027487 Enrollment ID: I20160215001353 |
Provider Name | Ronald Lee Barnes |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962469981 PECOS PAC ID: 2860473022 Enrollment ID: I20170522002928 |
Provider Name | Katrina Pendleton Borner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467988220 PECOS PAC ID: 7719257260 Enrollment ID: I20170717002549 |
Provider Name | Shawn Gerard Hughes |
---|---|
Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1033473772 PECOS PAC ID: 5698904449 Enrollment ID: I20170801000887 |
Provider Name | Connie Marie Slaughter |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104141928 PECOS PAC ID: 6709069636 Enrollment ID: I20170803001782 |
Provider Name | Brittany Nicole Grimes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013434570 PECOS PAC ID: 0143587048 Enrollment ID: I20171201000514 |
Provider Name | Katherine Lois Stuart |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679060198 PECOS PAC ID: 1254696859 Enrollment ID: I20180601000887 |
Provider Name | Patricia Ann Burnett |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295231421 PECOS PAC ID: 0648535922 Enrollment ID: I20180607003142 |
Provider Name | Poorita Singh |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336633718 PECOS PAC ID: 8426309873 Enrollment ID: I20180924001867 |
Provider Name | Jacob Aaron Urda |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427445477 PECOS PAC ID: 6608111869 Enrollment ID: I20181218000088 |
Provider Name | Brittany Anne Mosley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811452709 PECOS PAC ID: 5092054858 Enrollment ID: I20190222001650 |
Provider Name | Trena Rios |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326549809 PECOS PAC ID: 2860731718 Enrollment ID: I20190312000172 |
Provider Name | Brittany Marie Arbacheski Fais |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326607276 PECOS PAC ID: 9234467614 Enrollment ID: I20190822003017 |
Provider Name | Mitchell Drew Martineau |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417994815 PECOS PAC ID: 8123047065 Enrollment ID: I20191121001545 |
Provider Name | Marlon K Tudlong |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548801897 PECOS PAC ID: 0547694358 Enrollment ID: I20200103001631 |
Provider Name | Alison Harpring Colonna |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1497105118 PECOS PAC ID: 4486946589 Enrollment ID: I20200715001312 |
Provider Name | Julian Vladimirovich Tokarev |
---|---|
Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1629463732 PECOS PAC ID: 3870829807 Enrollment ID: I20200716001600 |
Provider Name | Tyler Hamilton |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265856819 PECOS PAC ID: 4183994882 Enrollment ID: I20200811000345 |
Provider Name | Eric Daniel Hinojosa |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629686878 PECOS PAC ID: 9830516301 Enrollment ID: I20200828001220 |
Provider Name | Helena Sylvia Richard |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538778378 PECOS PAC ID: 5597182972 Enrollment ID: I20200831002116 |
Provider Name | Julie Clausen Powell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053605857 PECOS PAC ID: 4981882313 Enrollment ID: I20201103002285 |
Provider Name | Shawn Lee |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043285091 PECOS PAC ID: 9436251444 Enrollment ID: I20201211002722 |
Provider Name | Madeline Maria-fernanda Strittmatter |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1962938233 PECOS PAC ID: 1850703950 Enrollment ID: I20201215000038 |
Provider Name | Laura Ann Bruck-hillas |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093301897 PECOS PAC ID: 6709299852 Enrollment ID: I20210108001195 |
Provider Name | Emily Bertsch |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356869267 PECOS PAC ID: 6002180809 Enrollment ID: I20210121000665 |
Provider Name | Karen Diane Hoffman |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154396018 PECOS PAC ID: 7719942226 Enrollment ID: I20210325000307 |
Provider Name | Shana Denise Haywood |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306428768 PECOS PAC ID: 6800205097 Enrollment ID: I20210428002451 |
Provider Name | Bryan Shane Robinson |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1841403441 PECOS PAC ID: 3274707856 Enrollment ID: I20210511002081 |
Provider Name | Melanie V Parm |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1710259981 PECOS PAC ID: 6608182399 Enrollment ID: I20210520001418 |
Provider Name | Kelley Michelle Coone |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013586130 PECOS PAC ID: 5193128460 Enrollment ID: I20210723001377 |
Provider Name | David Erickson |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1942390232 PECOS PAC ID: 3173856184 Enrollment ID: I20210824001660 |
Provider Name | Eudeum Lee Kim |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043980006 PECOS PAC ID: 9133526452 Enrollment ID: I20210928003827 |
Provider Name | Amanda Davis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205435518 PECOS PAC ID: 4183022205 Enrollment ID: I20211004002727 |
Provider Name | Cynthia Lynn Cuson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346676277 PECOS PAC ID: 6709013907 Enrollment ID: I20211124001520 |
Provider Name | Mary Jean Middleton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972009629 PECOS PAC ID: 6406108737 Enrollment ID: I20211221001539 |
Provider Name | Dale Volquartsen |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1841250594 PECOS PAC ID: 3173701174 Enrollment ID: I20220106002634 |
Provider Name | Tamara Louise Mckelvy |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699731687 PECOS PAC ID: 7810903473 Enrollment ID: I20220420002879 |
Provider Name | Melissa A Chrites |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1801216635 PECOS PAC ID: 4688996895 Enrollment ID: I20220502000464 |
Provider Name | Megan Walsh-aleem |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1891103644 PECOS PAC ID: 1557757952 Enrollment ID: I20220527001818 |
Provider Name | Nikkole Nunez Town |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164163325 PECOS PAC ID: 7214317650 Enrollment ID: I20220701002040 |
Provider Name | Glenn Raymond Fernandes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841356441 PECOS PAC ID: 5597086827 Enrollment ID: I20220718003883 |
Provider Name | Peter Hsu Shih |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1023006665 PECOS PAC ID: 4880678986 Enrollment ID: I20220912000040 |
Provider Name | Kyana Anthony |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043456213 PECOS PAC ID: 6709270283 Enrollment ID: I20221110003038 |
Provider Name | Annmarie Carucci Dowden |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194426601 PECOS PAC ID: 2668846908 Enrollment ID: I20230328001184 |
Provider Name | Ashley Theresa Cusson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346933892 PECOS PAC ID: 5496113896 Enrollment ID: I20230616000813 |
Provider Name | Stephanie Ann Wilson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386060929 PECOS PAC ID: 5395969661 Enrollment ID: I20230828002722 |
Provider Name | Steven John Hart |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1598982191 PECOS PAC ID: 5193867968 Enrollment ID: I20230918001123 |
Provider Name | Micheal Shane Blocker |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1487134052 PECOS PAC ID: 5698026862 Enrollment ID: I20240228001459 |
Provider Name | Kimberly Dawn Marshall |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538923297 PECOS PAC ID: 9335585728 Enrollment ID: I20240307002259 |
Provider Name | Hannah Lee Waters |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740898063 PECOS PAC ID: 8123464484 Enrollment ID: I20240308000698 |
Provider Name | Brianna Leigh Rider |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982372413 PECOS PAC ID: 0143662312 Enrollment ID: I20240521000491 |
Provider Name | Taylor Shannon Boone |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871344218 PECOS PAC ID: 6002258886 Enrollment ID: I20240524000587 |
Provider Name | Deneb Wright |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942068051 PECOS PAC ID: 0648712513 Enrollment ID: I20240606001915 |
Coastline Medical Services Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1817 Lewis Turner Blvd Ste F, Fort Walton Beach, FL 32547 Phone: 850-396-1110 | |
Family Medicine Associates Of The Emerald Coast P A Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 348 Miracle Strip Pkwy Sw, Suite 23, Fort Walton Beach, FL 32548 Phone: 850-269-2186 Fax: 850-269-2341 | |
James P Wilson Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 Cloverdale Blvd, Fort Walton Beach, FL 32547 Phone: 850-862-7604 Fax: 850-862-8156 | |
Glass Inpatient Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 Mar Walt Dr, Fort Walton Beach, FL 32547 Phone: 850-862-1111 | |
White-wilson Med Ctr-fwb Fp Dept Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1005 Mar Walt Dr, Fp Department, Fort Walton Beach, FL 32547 Phone: 850-863-6600 Fax: 850-862-0977 | |
Bridgeway Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 137 Hospital Dr Ne, Fort Walton Beach, FL 32548 Phone: 850-226-8857 Fax: 850-226-8859 | |
Saint George Medical Center Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1118 Hospital Rd, Fort Walton Beach, FL 32547 Phone: 850-862-3415 |