Provider Demographics
NPI:1619285947
Name:COX, JOHN DAVID JR (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:COX
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MIRACLE STRIP PKWY SW
Mailing Address - Street 2:UNIT 1103
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6650
Mailing Address - Country:US
Mailing Address - Phone:850-226-2212
Mailing Address - Fax:
Practice Address - Street 1:124 MIRACLE STRIP PKWY SW
Practice Address - Street 2:UNIT 1103
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-6650
Practice Address - Country:US
Practice Address - Phone:850-226-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3403612163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse