Provider Demographics
NPI:1851860951
Name:NORTHWEST FLORIDA GERIATRICS LLC
Entity Type:Organization
Organization Name:NORTHWEST FLORIDA GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HODSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-384-8969
Mailing Address - Street 1:5997 CHERRY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9382
Mailing Address - Country:US
Mailing Address - Phone:850-384-8969
Mailing Address - Fax:
Practice Address - Street 1:5530 NORTHROP RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8701
Practice Address - Country:US
Practice Address - Phone:850-983-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101613300Medicaid