Diana Health FL P.a.
Organization Active NPI Obstetrics & Gynecology Physician · Fort Walton Beach, FL
NPI 1194591966 · NPPES record last updated Nov 24, 2025
Key facts
- NPI
- 1194591966
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- DIANA HEALTH FL P.A.
- Practice address
- 1046 Mar Walt Dr
Suite 200
Fort Walton Beach, FL 32547 - Phone
- (850) 243-2229
- NPI assigned
- Dec 1, 2023
- Organization subpart
- No
Authorized official
- Name
- Caitlin Eisenbarth
- Title
- Payer Relations
- Phone
- (850) 243-2229
Practitioners 89
-
Pamala Ann Clayton, CNM
-
Tori Michelle Cruikshank, APRN
-
Elizabeth Michelle Derminer, CNM/WHNP
-
Luz Anuri Drummond, N.P.
-
Marcella Facey, MD
-
Tonya Renee Hawkes, CNM, APRN
-
Michael Hennessey, M. D.
-
Shannon Hughes, APRN
-
Christine Johnson, WHNP
-
Heather Mooneyhan, MSN, APN, CNM
-
Kathryn Nolan, NP
-
Kimberly D Parks, CNM
-
Alexcia Dawn Pennell, CNM, FNP-C
-
Shawn Robert Ramsey, D.O.
-
Miles Byrd, M.D.
-
Charles A Debrah, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D1050081 | Diana Health FL, PA | Certificate of waiver | Jan 24, 2028 |
| 10D2316649 | Diana Health FL PA | Certificate of waiver | Mar 11, 2027 |
| 10D2330915 | Diana Health FL PA | Certificate of waiver | Sep 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240819002808 | FL | Part B Supplier - Clinic/Group Practice | 5092253245 |
Receives reassigned benefits from 81 practitioners Practice locations: Tallahassee, FL; Orange City, FL; Fort Walton Beach, FL; Jacksonville, FL |
National Provider Directory
Locations
1046 Mar Walt Dr
Ste 200
Fort Walton Beach, FL 32547
Phone (850) 243-2229
907 Mar Walt Dr
Ste 2024
Ft Walton Bch, FL 32547
Phone (850) 243-2229
3627 University Blvd S
Ste 200
Jacksonville, FL 32216
Phone (904) 296-3200
178 Columbus Ave
Unit 237190
New York, NY 10023
Phone (347) 941-0030
Interoperability endpoints
- https://api.platform.athenahealth.com/23211/brand/1/csg/21/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Clinical Social Worker |
1041C0700X | |||
| Obstetrics & Gynecology Physician |
207V00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | |||
| Women's Health Nurse Practitioner |
363LW0102X | |||
| Advanced Practice Midwife |
367A00000X |
Addresses
Primary practice location
1046 Mar Walt Dr
Suite 200
Fort Walton Beach, FL 32547
Mailing address
178 Columbus Ave
#237190 SMB#33783
New York, NY 10023
Other practice location 1
3627 University Blvd S Ste 200
Jacksonville, FL 32216-4256
Phone (904) 296-3200
Other practice location 2
2770 Capital Medical Blvd Ste 220
Tallahassee, FL 32308-8417
Phone (850) 391-3880
Other practice location 3
1061 Medical Center Dr Ste 102
Orange City, FL 32763-8225
Phone (386) 456-3852
Other providers in Fort Walton Beach, FL
- Erica Desouza-Fite
- Karin Despiegelaere
- Carver Gray Dethloff
- Kirstie Devita
- Peter R. Devuyst
- Ronald G. Dibble
- Ebonye Junae Dickens
- Debra E Diemand
- Pamela Diffee
- Digital Hearing Instruments
All providers in Fort Walton Beach, FL · Obstetrics & Gynecology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.