Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Crestview Hospital Corporation

Organization Family Medicine Physician · NPI 1629026133

Crestview Hospital Corporation is a Family Medicine Physician in Crestview, Florida. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3

Practice location Address checks out

127C E Redstone Ave
Crestview, FL 32539-5356
Phone: (850) 423-0061
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Rural Health Clinic/Center Taxonomy 261QR1300X

Record details

NPI number1629026133
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Jackson — Sr Dir Onboarding & Prov Enrollment · (615) 465-3334
Other names Gateway Medical Clinic; Gateway Medical Clinic
NPI enumeratedMay 5, 2006
Last updated in NPPESMarch 18, 2022
Certification dateFebruary 14, 2022
Mailing address330 Franklin Rd # 135a-316, Brentwood, TN 37027-3280

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