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3606 Maclay Blvd S Ste 102 Tallahassee FL 32312-1277 | |
| (850) 999-2996 | |
| (850) 536-6439 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3606 Maclay Blvd S Ste 102, Tallahassee, Florida |
| Authorized Official Name and Position | Julianne Folsom (OWNER) |
| Authorized Official Contact | 8505669190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3606 Maclay Blvd S Ste 102 Tallahassee FL 32312-1277 Ph: (850) 999-2996 | 3606 Maclay Blvd S Ste 102 Tallahassee FL 32312-1277 Ph: (850) 999-2996 |
| NPI Number | 1659940377 |
|---|---|
| Provider Enumeration Date | 06/18/2021 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Medicare PECOS PAC ID | 3971900929 |
|---|---|
| Medicare Enrollment ID | O20210920000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659940377 | NPI | - | NPPES |
| Provider Name | Ryan W Novince |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164865259 PECOS PAC ID: 6204062029 Enrollment ID: I20200219002203 |
| Provider Name | Julianne K Folsom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629691225 PECOS PAC ID: 4082025440 Enrollment ID: I20201117000228 |
| Provider Name | Heather L Chasteen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487225280 PECOS PAC ID: 8022411636 Enrollment ID: I20210720002575 |
| Provider Name | Kathryn Flagg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326708322 PECOS PAC ID: 4789129156 Enrollment ID: I20240709004933 |
| Provider Name | Lynette Battles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427534650 PECOS PAC ID: 6305384264 Enrollment ID: I20240812000043 |
| Provider Name | Beidemariam Milton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639927304 PECOS PAC ID: 6305384819 Enrollment ID: I20240815001106 |
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