| Brevard Geriatrics, Llc | |
|
720 E New Haven Ave Suite 11 Melbourne FL 32901-5474 | |
| (321) 724-4545 | |
| (321) 728-4168 |
| Full Name | Brevard Geriatrics, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 720 E New Haven Ave Suite 11, Melbourne, Florida |
| Authorized Official Name and Position | John Potomski (OWNER) |
| Authorized Official Contact | 3214465893 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brevard Geriatrics, Llc 720 E New Haven Ave Suite 11 Melbourne FL 32901-5474 Ph: (321) 724-4545 | Brevard Geriatrics, Llc 720 E New Haven Ave Suite 11 Melbourne FL 32901-5474 Ph: (321) 724-4545 |
| NPI Number | 1225682784 |
|---|---|
| Provider Enumeration Date | 08/01/2019 |
| Last Update Date | 08/01/2019 |
| Medicare PECOS PAC ID | 5890025167 |
|---|---|
| Medicare Enrollment ID | O20190930001833 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225682784 | NPI | - | NPPES |
| 067596200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Joanna L Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316902034 PECOS PAC ID: 7113989369 Enrollment ID: I20041029000682 |
| Provider Name | Michelle Antoinette Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659336634 PECOS PAC ID: 7416992128 Enrollment ID: I20050623000126 |
| Provider Name | John Potomski |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1083657183 PECOS PAC ID: 7416080759 Enrollment ID: I20100806000228 |
| Provider Name | Cynthia D Heyne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831588185 PECOS PAC ID: 1355661497 Enrollment ID: I20150513001728 |
| Provider Name | Tracy J Rapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427555838 PECOS PAC ID: 1951640473 Enrollment ID: I20190228000405 |
| Provider Name | Christine A Festa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255803649 PECOS PAC ID: 2264762913 Enrollment ID: I20190924001848 |
| Provider Name | Mary Rachael Hutchison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225650898 PECOS PAC ID: 1456770700 Enrollment ID: I20201006001301 |
| Provider Name | Lisa Mercado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770181182 PECOS PAC ID: 9133532070 Enrollment ID: I20210113002040 |
| Provider Name | Melissa Rachel Scully |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356989156 PECOS PAC ID: 9638584956 Enrollment ID: I20210219000570 |
| Provider Name | Abigail Marie Seeback |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740871011 PECOS PAC ID: 1759798903 Enrollment ID: I20210406000318 |
| Provider Name | Georgiana Moorhead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326254269 PECOS PAC ID: 7012130172 Enrollment ID: I20220131000475 |
| Provider Name | Ira M Walter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427232107 PECOS PAC ID: 3072908672 Enrollment ID: I20220317001763 |
| Provider Name | Laura Beth Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649925009 PECOS PAC ID: 0345627873 Enrollment ID: I20220521000299 |
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