Nolan Mark Renner, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9108565 Issued in FL

Practice address

341 Racetrack Rd NW Ste C
Fort Walton Beach, FL 32547-1788

Phone

(850) 226-8112

Fax

(850) 362-6068

NPI assigned

Feb 18, 2015

Last updated

Sep 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hughston Clinic Southeast PCGroup PAC ID 9234423971, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223
• North Okaloosa Medical Center Hospital, Crestview, FL, CCN 100122

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nolan.renner.2@321.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hughston Clinic Southeast PC

  • Orthopaedic Surgery Physician
  • Columbus, GA
  • NPI 1225401946

  FL

  Medicare reassignment Care Compare group NPD
• Hughston Clinic Southeast PC

  • Durable Medical Equipment & Medical Supplies
  • Nashville, TN
  • NPI 1770004863
  NPD
• Hughston Clinic Southeast PC

  • Durable Medical Equipment & Medical Supplies
  • Fort Walton Beach, FL
  • NPI 1598286684
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Crestview Hospital Company, LLC

  dba North Okaloosa Medical Center

  • General Acute Care Hospital
  • Crestview, FL
  • NPI 1104897859
  Care Compare affiliation
• Fort Walton Beach Medical Center, Inc.

  dba HCA Florida Fort Walton-Destin Hospital

  • General Acute Care Hospital
  • Fort Walton Beach, FL
  • NPI 1639128820
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1174914758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "fax_number": "706-494-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 RACETRACK RD NW STE C",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471788",
            "telephone_number": "850-226-8112",
            "fax_number": "850-362-6068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "NOLAN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-18",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9108565",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9108565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monique Reid
• Sean Christopher Reid
• Renal Care Group of the Southeast, Inc. (Renal Care Group Ft. Walton Beach)
• Renal Treatment Centers - Southeast, LP (Fort Walton Beach Dialysis)
• Megan Kayla Renner, PA-C
• Nataliya V Reno, ARNP
• Michael William Restey, M.D.
• Kimberly Ret, APRN
• Erica Retallick
• Retreat at Fort Walton Beach Opco LLC (The Retreat at Fort Walton Beach)

• Surgical Physician Assistant in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.