| Primary Care Services At Azalea Trace | |
|
10100 Hillview Drive Pensacola FL 32514 | |
| (850) 478-5200 | |
| (850) 474-0558 |
| Full Name | Primary Care Services At Azalea Trace |
|---|---|
| Speciality | Internal Medicine |
| Location | 10100 Hillview Drive, Pensacola, Florida |
| Authorized Official Name and Position | Susan Ahern (SVP, CFO) |
| Authorized Official Contact | 2156618330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Services At Azalea Trace 420 Delaware Dr Fort Washington PA 19034-2711 Ph: (267) 787-4097 | Primary Care Services At Azalea Trace 10100 Hillview Drive Pensacola FL 32514 Ph: (850) 478-5200 |
| NPI Number | 1215326335 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 02/20/2024 |
| Medicare PECOS PAC ID | 5092032284 |
|---|---|
| Medicare Enrollment ID | O20160512001716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215326335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Deborah F Bray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841286143 PECOS PAC ID: 3375527526 Enrollment ID: I20040615001281 |
| Provider Name | Susan F Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093998973 PECOS PAC ID: 3678635364 Enrollment ID: I20081213000212 |
| Provider Name | Cheryl A Homer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801294707 PECOS PAC ID: 5193032555 Enrollment ID: I20150916003376 |
| Provider Name | Lisa A Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144340704 PECOS PAC ID: 2668740481 Enrollment ID: I20170620003370 |
| Provider Name | Lisy Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811474489 PECOS PAC ID: 9830430628 Enrollment ID: I20190404000066 |
| Provider Name | Meghan A Mcmackin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316981798 PECOS PAC ID: 7719985316 Enrollment ID: I20200408000026 |
| Provider Name | Tammy Helton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760044044 PECOS PAC ID: 7416109509 Enrollment ID: I20200604002607 |
| Provider Name | Deana Beard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376630491 PECOS PAC ID: 1850337874 Enrollment ID: I20221110002078 |
| Provider Name | Kerry Peete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639530934 PECOS PAC ID: 8426341637 Enrollment ID: I20231222002071 |
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