Provider Demographics
NPI:1154953743
Name:LOFTIS, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6954 ELLIOTS GIN LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8587
Mailing Address - Country:US
Mailing Address - Phone:251-327-7026
Mailing Address - Fax:
Practice Address - Street 1:930 MAR WALT DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6706
Practice Address - Country:US
Practice Address - Phone:850-226-6801
Practice Address - Fax:877-413-5104
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant