Basic Information
| Provider Information | |||||||||
| NPI: | 1164602058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORELOCK | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | JOHANNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2699 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325132699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504754500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7720 US HIGHWAY 98 W | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MIRAMAR BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325507230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502671603 | ||||||||
| FaxNumber: | 8502671862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME106715 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002230500 | 05 | FL | MEDICAID |