| Emerald Coast Memory Clinic, Llc | |
|
755 Grand Blvd Ste 105b278 Miramar Beach FL 32550-1838 | |
| (850) 737-1816 | |
| Not Available |
| Full Name | Emerald Coast Memory Clinic, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 755 Grand Blvd Ste 105b278, Miramar Beach, Florida |
| Authorized Official Name and Position | Farid Chekaoui (MGRM) |
| Authorized Official Contact | 8507371816 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerald Coast Memory Clinic, Llc 755 Grand Blvd Ste 105b278 Miramar Beach FL 32550-1838 Ph: () - | Emerald Coast Memory Clinic, Llc 755 Grand Blvd Ste 105b278 Miramar Beach FL 32550-1838 Ph: (850) 737-1816 |
| NPI Number | 1962911651 |
|---|---|
| Provider Enumeration Date | 09/25/2017 |
| Last Update Date | 09/25/2017 |
| Medicare PECOS PAC ID | 4486911641 |
|---|---|
| Medicare Enrollment ID | O20171127002423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962911651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME86872 (Florida) | Primary |
| Provider Name | Farid Chekaoui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326056813 PECOS PAC ID: 2466344437 Enrollment ID: I20040922000408 |
| Provider Name | Rachael V Burnetsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245471002 PECOS PAC ID: 5092864744 Enrollment ID: I20090528000591 |
| Provider Name | Kimberly A Burnsed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861776163 PECOS PAC ID: 5193968907 Enrollment ID: I20130827000249 |
| Provider Name | Sara A Lepisto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497066245 PECOS PAC ID: 1759415144 Enrollment ID: I20150416001263 |
| Provider Name | Brittany N Whitfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982296984 PECOS PAC ID: 2264848324 Enrollment ID: I20210316000142 |
| Provider Name | Tabitha M World |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760076442 PECOS PAC ID: 5294143111 Enrollment ID: I20210414001025 |
| Provider Name | Kristi A Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699441725 PECOS PAC ID: 8426456740 Enrollment ID: I20211018000277 |
| Provider Name | Benjamin R Glidden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093485427 PECOS PAC ID: 4789072679 Enrollment ID: I20211026002067 |
| Provider Name | Johndell Directo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881388379 PECOS PAC ID: 8224491147 Enrollment ID: I20230825000295 |
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