| Century Clinical Family Medicine, Llc. | |
|
1410 Lpga Blvd Ste. 140 Daytona Beach FL 32117-5115 | |
| (386) 274-4750 | |
| Not Available |
| Full Name | Century Clinical Family Medicine, Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1410 Lpga Blvd, Daytona Beach, Florida |
| Authorized Official Name and Position | Thomas L Gaskin (CFO) |
| Authorized Official Contact | 3862744750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Century Clinical Family Medicine, Llc. 1410 Lpga Blvd Ste. 140 Daytona Beach FL 32117-5115 Ph: (386) 274-4750 | Century Clinical Family Medicine, Llc. 1410 Lpga Blvd Ste. 140 Daytona Beach FL 32117-5115 Ph: (386) 274-4750 |
| NPI Number | 1710211289 |
|---|---|
| Provider Enumeration Date | 09/30/2009 |
| Last Update Date | 11/04/2009 |
| Medicare PECOS PAC ID | 0042358996 |
|---|---|
| Medicare Enrollment ID | O20091112000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710211289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | ARNP9211084 (Florida) | Secondary |
| Provider Name | Blanca C Luna |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891730974 PECOS PAC ID: 2062571946 Enrollment ID: I20081106000662 |
| Provider Name | Tina Gail Gaskin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235463266 PECOS PAC ID: 5395883243 Enrollment ID: I20091112000636 |
| Provider Name | Aaron Porter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821250721 PECOS PAC ID: 7012164064 Enrollment ID: I20150224000788 |
| Provider Name | Michelle Guirand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609373935 PECOS PAC ID: 7012271489 Enrollment ID: I20180510002615 |
| Provider Name | Humberto Paez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992204291 PECOS PAC ID: 2163777608 Enrollment ID: I20180625000682 |
| Provider Name | Leoni C King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659029429 PECOS PAC ID: 2062880115 Enrollment ID: I20221121001028 |
| Provider Name | Brittany Canidate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457133225 PECOS PAC ID: 5799132221 Enrollment ID: I20231106001660 |
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