| Beacon Primary Care Llc | |
|
17819 Tidewater Bay Ln Lutz FL 33549-5419 | |
| (813) 447-9249 | |
| Not Available |
| Full Name | Beacon Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 17819 Tidewater Bay Ln, Lutz, Florida |
| Authorized Official Name and Position | Tyler Penrod (BILLER) |
| Authorized Official Contact | 8322899225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Primary Care Llc 17819 Tidewater Bay Ln Lutz FL 33549-5419 Ph: (813) 447-9249 | Beacon Primary Care Llc 17819 Tidewater Bay Ln Lutz FL 33549-5419 Ph: (813) 447-9249 |
| NPI Number | 1184384349 |
|---|---|
| Provider Enumeration Date | 12/29/2021 |
| Last Update Date | 12/29/2021 |
| Medicare PECOS PAC ID | 3375936008 |
|---|---|
| Medicare Enrollment ID | O20220202000062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184384349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sonia Segui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780126052 PECOS PAC ID: 5496036527 Enrollment ID: I20170104001971 |
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