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

Emerald Coast Dermatology & Skin Surgery Center P A

Organization Dermatology Physician · NPI 1386639912

Emerald Coast Dermatology & Skin Surgery Center P A is a Dermatology Physician in Crestview, Florida. Licensed in Florida. Registered with an NPI since 2005.

Licensed in
FL
In the registry since
2005

Practice location Address checks out

350 Redstone Ave W
Crestview, FL 32536-6433
Phone: (850) 689-1740
Fax: (850) 682-6652
Show map & directions

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

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence ME0061435 (FL)

Record details

NPI number1386639912
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jillian Owens — Credentialing And Contracting · (850) 689-1740
NPI enumeratedSeptember 20, 2005
Last updated in NPPESJanuary 20, 2026
Certification dateJanuary 20, 2026
Mailing address350 Redstone Ave W, Crestview, FL 32536-6433

Other providers in Crestview