| Cgr Beacon Clinic, Pa | |
|
3782 Tamiami Trl Port Charlotte FL 33952-8353 | |
| (941) 629-7855 | |
| (941) 629-9589 |
| Full Name | Cgr Beacon Clinic, Pa |
|---|---|
| Speciality | Counselor |
| Location | 3782 Tamiami Trl, Port Charlotte, Florida |
| Authorized Official Name and Position | Charlene Joan Rosenfield (ARNP) |
| Authorized Official Contact | 9416297855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cgr Beacon Clinic, Pa Po Box 496080 Port Charlotte FL 33949-6080 Ph: (941) 629-7855 | Cgr Beacon Clinic, Pa 3782 Tamiami Trl Port Charlotte FL 33952-8353 Ph: (941) 629-7855 |
| NPI Number | 1841220811 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2466456843 |
|---|---|
| Medicare Enrollment ID | O20060828000449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841220811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | ARNP2935382 (Florida) | Primary |
| Provider Name | Charlene J Rosenfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295778835 PECOS PAC ID: 7810909108 Enrollment ID: I20060828000437 |
| Provider Name | Thomas Albert Willingham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285678805 PECOS PAC ID: 9436155322 Enrollment ID: I20061017000432 |
| Provider Name | Kathleen Ann Kaloski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922273846 PECOS PAC ID: 6002988870 Enrollment ID: I20080710000690 |
| Provider Name | Chantelle M Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780855312 PECOS PAC ID: 1759454747 Enrollment ID: I20080724000274 |
| Provider Name | Alicia Uselmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992067136 PECOS PAC ID: 0042449662 Enrollment ID: I20140131000340 |
| Provider Name | Colleen N Hosp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962826024 PECOS PAC ID: 3577866433 Enrollment ID: I20160127000247 |
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