| Lifesource Of North Carolina | |
|
5530 Northrop Rd Milton FL 32570-8701 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Psychologist |
| Location | 5530 Northrop Rd, Milton, Florida |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 794-4521 | Lifesource Of North Carolina 5530 Northrop Rd Milton FL 32570-8701 Ph: (910) 742-9243 |
| NPI Number | 1730648288 |
|---|---|
| Provider Enumeration Date | 03/14/2019 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20190327002120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730648288 | NPI | - | NPPES |
| Provider Name | Maureen D Kapatkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740381458 PECOS PAC ID: 4385706506 Enrollment ID: I20081223000312 |
| Provider Name | Shirley J Tabor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780922500 PECOS PAC ID: 5193979441 Enrollment ID: I20130214000074 |
| Provider Name | Merri Schiff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154747137 PECOS PAC ID: 9335461268 Enrollment ID: I20141204000854 |
| Provider Name | Hassan Ayaz Bokhari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811158082 PECOS PAC ID: 2062653462 Enrollment ID: I20150721002094 |
| Provider Name | Barbara Joan Rubin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669801551 PECOS PAC ID: 7911241179 Enrollment ID: I20190401000642 |
| Provider Name | Willie James Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417217092 PECOS PAC ID: 1456500545 Enrollment ID: I20200414000690 |
| Provider Name | Shakila Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891339099 PECOS PAC ID: 8820429434 Enrollment ID: I20200515000618 |
| Provider Name | Jana Erika Cua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225491087 PECOS PAC ID: 6608160635 Enrollment ID: I20200615001481 |
| Provider Name | Emmanuella Armand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447863345 PECOS PAC ID: 6406267095 Enrollment ID: I20201203001475 |
| Provider Name | Salim Elhalaby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750658662 PECOS PAC ID: 9436414067 Enrollment ID: I20210702000694 |
| Provider Name | Terraseeta Craig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366908287 PECOS PAC ID: 9739574021 Enrollment ID: I20220705003146 |
| Provider Name | Paige Marenah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942650791 PECOS PAC ID: 6608114574 Enrollment ID: I20221203000401 |
| Provider Name | Kayla Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023701307 PECOS PAC ID: 9931569357 Enrollment ID: I20231004000850 |
| Provider Name | Audrea Maurine Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124161153 PECOS PAC ID: 8325496144 Enrollment ID: I20231204002907 |
| Provider Name | Shannon Pereira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245849645 PECOS PAC ID: 6406241579 Enrollment ID: I20231215000268 |
| Provider Name | Jean L Kraljev |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487096814 PECOS PAC ID: 1658337704 Enrollment ID: I20240420000266 |
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