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4250 Philips Hwy # 100 Jacksonville FL 32207-6730 | |
| (904) 839-1018 | |
| (904) 656-7279 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4250 Philips Hwy # 100, Jacksonville, Florida |
| Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
| Authorized Official Contact | 4074477120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (407) 447-7120 | 4250 Philips Hwy # 100 Jacksonville FL 32207-6730 Ph: (904) 839-1018 |
| NPI Number | 1003643214 |
|---|---|
| Provider Enumeration Date | 09/19/2024 |
| Last Update Date | 12/10/2024 |
| Medicare PECOS PAC ID | 5698206167 |
|---|---|
| Medicare Enrollment ID | O20241008003187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003643214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | George Toth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295787521 PECOS PAC ID: 7012988363 Enrollment ID: I20040802001199 |
| Provider Name | Farid Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205018843 PECOS PAC ID: 0749355295 Enrollment ID: I20080818000440 |
| Provider Name | Angelica U Doloroso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194979393 PECOS PAC ID: 9436211778 Enrollment ID: I20081222000258 |
| Provider Name | Nanako Broughton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386710184 PECOS PAC ID: 5799723771 Enrollment ID: I20140328001894 |
| Provider Name | Sravan Thangeda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487876439 PECOS PAC ID: 5294818928 Enrollment ID: I20151030001749 |
| Provider Name | Raquel Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790223386 PECOS PAC ID: 9931485711 Enrollment ID: I20170410001556 |
| Provider Name | Jennifer A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174115067 PECOS PAC ID: 5799191854 Enrollment ID: I20210316000235 |
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