| Ardent Family Care Pa | |
|
84 Pinnacles Dr Ste 200 Palm Coast FL 32164-2324 | |
| (386) 439-9777 | |
| (386) 206-0015 |
| Full Name | Ardent Family Care Pa |
|---|---|
| Speciality | General Practice |
| Location | 84 Pinnacles Dr Ste 200, Palm Coast, Florida |
| Authorized Official Name and Position | Renato Ascensio Alfonso (PRESIDENT) |
| Authorized Official Contact | 3864399777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ardent Family Care Pa 84 Pinnacles Dr Ste 200 Palm Coast FL 32164-2324 Ph: (386) 439-9777 | Ardent Family Care Pa 84 Pinnacles Dr Ste 200 Palm Coast FL 32164-2324 Ph: (386) 439-9777 |
| NPI Number | 1225131477 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 07/15/2009 |
| Medicare PECOS PAC ID | 7517933419 |
|---|---|
| Medicare Enrollment ID | O20040902000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225131477 | NPI | - | NPPES |
| 253950100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | D049 (Florida) | Primary |
| Provider Name | Augusto De Leon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982664165 PECOS PAC ID: 1850372269 Enrollment ID: I20040601000079 |
| Provider Name | Don Joseph Alfonso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073508917 PECOS PAC ID: 8527022805 Enrollment ID: I20100223000790 |
| Provider Name | Renato A Alfonso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184619017 PECOS PAC ID: 3870569775 Enrollment ID: I20100223000817 |
| Provider Name | Rachel M Dailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164861951 PECOS PAC ID: 7113169566 Enrollment ID: I20130814000362 |
| Provider Name | Mary K Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194962241 PECOS PAC ID: 7719114073 Enrollment ID: I20131211001021 |
| Provider Name | Robert Bruce Perri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891179693 PECOS PAC ID: 0244548295 Enrollment ID: I20150924002851 |
| Provider Name | Mirian G Langer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174975908 PECOS PAC ID: 9830479104 Enrollment ID: I20161201002012 |
| Provider Name | Charles Alan Cantrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801317219 PECOS PAC ID: 1759708746 Enrollment ID: I20200908000728 |
| Provider Name | Tacha H Souverain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518633767 PECOS PAC ID: 2163890278 Enrollment ID: I20221122000230 |
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