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1750 17th St Ste J2 Sarasota FL 34234-8690 | |
| (941) 366-5333 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1750 17th St Ste J2, Sarasota, Florida |
| Authorized Official Name and Position | Katie Brim (CONTRACTING COORDINATOR) |
| Authorized Official Contact | 9413665333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4579 Northgate Ct Sarasota FL 34234-2124 Ph: (941) 552-2078 | 1750 17th St Ste J2 Sarasota FL 34234-8690 Ph: (941) 366-5333 |
| NPI Number | 1578551198 |
|---|---|
| Provider Enumeration Date | 10/07/2005 |
| Last Update Date | 08/02/2023 |
| Certification Date | 08/02/2023 |
| Medicare PECOS PAC ID | 9830324169 |
|---|---|
| Medicare Enrollment ID | O20131022002115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578551198 | NPI | - | NPPES |
| 003605400 | Medicaid | FL |
| Provider Name | Deborah L Lorshbough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508883380 PECOS PAC ID: 5294918876 Enrollment ID: I20110318000486 |
| Provider Name | Mario C Oliva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790824936 PECOS PAC ID: 1658555784 Enrollment ID: I20110413000848 |
| Provider Name | Delia Monroe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043524895 PECOS PAC ID: 4385893825 Enrollment ID: I20120927000366 |
| Provider Name | Frederic L Monosiet |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528230828 PECOS PAC ID: 7416275268 Enrollment ID: I20150408000284 |
| Provider Name | Joseph Calleja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952695447 PECOS PAC ID: 5092958421 Enrollment ID: I20160113002691 |
| Provider Name | Marina Nesterenko |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346404118 PECOS PAC ID: 0244406106 Enrollment ID: I20161029000279 |
| Provider Name | Jessica D Pritchard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609323955 PECOS PAC ID: 2769767425 Enrollment ID: I20170320000948 |
| Provider Name | Melissa S Carafelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316405996 PECOS PAC ID: 7012259591 Enrollment ID: I20200729001222 |
| Provider Name | Roshunya Shavon Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497292049 PECOS PAC ID: 1951569466 Enrollment ID: I20201023001090 |
| Provider Name | Christina Burge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861087058 PECOS PAC ID: 2860880812 Enrollment ID: I20211025003225 |
| Provider Name | Sreejithkumar Sasidharan Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710579669 PECOS PAC ID: 5799150934 Enrollment ID: I20230331001317 |
| Provider Name | Amanda Merkel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588118913 PECOS PAC ID: 1759730054 Enrollment ID: I20231212002810 |
| Provider Name | Lynn Ruffolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083471486 PECOS PAC ID: 0840630539 Enrollment ID: I20240429001423 |
| Provider Name | Jade Suggs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811746563 PECOS PAC ID: 3870038433 Enrollment ID: I20240709000086 |
| Provider Name | Sarah Nigro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518718964 PECOS PAC ID: 8729513940 Enrollment ID: I20241125004418 |
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