| Ascension Internal Medicine Of Florida, Llc | |
|
1426 Canyon Ave Ne Ste C Live Oak FL 32064-4832 | |
| (386) 208-0537 | |
| (386) 208-0571 |
| Full Name | Ascension Internal Medicine Of Florida, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1426 Canyon Ave Ne Ste C, Live Oak, Florida |
| Authorized Official Name and Position | Malik M Naqi (DIRECTOR) |
| Authorized Official Contact | 3862080537 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ascension Internal Medicine Of Florida, Llc 8924 Sw 15th Ave Gainesville FL 32607-7014 Ph: (269) 277-3536 | Ascension Internal Medicine Of Florida, Llc 1426 Canyon Ave Ne Ste C Live Oak FL 32064-4832 Ph: (386) 208-0537 |
| NPI Number | 1811233505 |
|---|---|
| Provider Enumeration Date | 12/27/2012 |
| Last Update Date | 12/10/2020 |
| Medicare PECOS PAC ID | 8022263417 |
|---|---|
| Medicare Enrollment ID | O20130311000370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811233505 | NPI | - | NPPES |
| 008086300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Farrukh Ambareen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063404457 PECOS PAC ID: 0547364267 Enrollment ID: I20070404000536 |
| Provider Name | Mohammad Taqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972595254 PECOS PAC ID: 9133033426 Enrollment ID: I20070427000437 |
| Provider Name | Malik Naqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083881668 PECOS PAC ID: 1254404346 Enrollment ID: I20080723000254 |
| Provider Name | April Marie Bayless-sakellarios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942621719 PECOS PAC ID: 9234445529 Enrollment ID: I20190507002333 |
| Provider Name | Kristina Melissa North |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114574548 PECOS PAC ID: 1557692894 Enrollment ID: I20191017000526 |
| Provider Name | Jennifer Poucher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255084976 PECOS PAC ID: 7113311184 Enrollment ID: I20220308002828 |
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Shands Medical Group Of Live Oak-rhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1426 Canyon Ave Ne, Unit B, Live Oak, FL 32064 Phone: 386-208-0537 | |
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