Individual provider Active NPI

Cornelia Denise Justice, RN

  • Ambulatory Women's Health Care Registered Nurse
  • Fort Walton Beach, FL
National Provider Identifier
1528923034
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Women's Health Care Registered NurseTaxonomy code 163WW0101X
License
R254610 Issued in MD
Practice address
1515 Ponderosa Rd W
Fort Walton Beach, FL 32547-1124
Phone
(301) 836-8891
NPI assigned
Dec 17, 2025
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Women's Health Care Registered Nurse 163WW0101X R254610 MD Primary

Addresses

Primary practice location

1515 Ponderosa Rd W
Fort Walton Beach, FL 32547-1124

Mailing address

1515 Ponderosa Rd W
Fort Walton Beach, FL 32547-1124
Phone (301) 836-8891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R254610MDMDAmbulatory Women's Health Care Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1765929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1528923034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PONDEROSA RD W",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471124",
            "telephone_number": "301-836-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PONDEROSA RD W",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471124",
            "telephone_number": "301-836-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTICE",
        "first_name": "CORNELIA",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-17",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0101X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Women's Health Care, Ambulatory",
            "state": "MD",
            "license": "R254610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.