| Advantage Primary Care, Pllc | |
|
20212 E Pennsylvania Ave Ste B Dunnellon FL 34432-6032 | |
| (352) 484-0422 | |
| (352) 484-1430 |
| Full Name | Advantage Primary Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 20212 E Pennsylvania Ave Ste B, Dunnellon, Florida |
| Authorized Official Name and Position | Tracy L Riddle (OWNER/PRACTITIONER) |
| Authorized Official Contact | 3524840422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advantage Primary Care, Pllc 20212 E Pennsylvania Ave Ste B Dunnellon FL 34432-6032 Ph: (352) 484-0422 | Advantage Primary Care, Pllc 20212 E Pennsylvania Ave Ste B Dunnellon FL 34432-6032 Ph: (352) 484-0422 |
| NPI Number | 1871062307 |
|---|---|
| Provider Enumeration Date | 11/14/2018 |
| Last Update Date | 11/14/2018 |
| Medicare PECOS PAC ID | 1759628217 |
|---|---|
| Medicare Enrollment ID | O20190123000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871062307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shirley A Ice |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972581288 PECOS PAC ID: 1355467804 Enrollment ID: I20100922000419 |
| Provider Name | Tracy L Riddle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083890271 PECOS PAC ID: 3476850876 Enrollment ID: I20160330001674 |
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