| Dacona Medical Center | |
|
4109 N Armenia Ave Ste A Tampa FL 33607-6411 | |
| (813) 588-3342 | |
| (813) 588-3602 |
| Full Name | Dacona Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 4109 N Armenia Ave Ste A, Tampa, Florida |
| Authorized Official Name and Position | Estrella Gonzalez (CEO) |
| Authorized Official Contact | 8135883342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dacona Medical Center 4109 N Armenia Ave Ste A Tampa FL 33607-6411 Ph: (813) 588-3342 | Dacona Medical Center 4109 N Armenia Ave Ste A Tampa FL 33607-6411 Ph: (813) 588-3342 |
| NPI Number | 1174118608 |
|---|---|
| Provider Enumeration Date | 03/05/2021 |
| Last Update Date | 04/22/2024 |
| Medicare PECOS PAC ID | 9537567250 |
|---|---|
| Medicare Enrollment ID | O20211012000060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174118608 | NPI | - | NPPES |
| 120219100 | Medicaid | FL | |
| 111242300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Nicole Bilodeau |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316038706 PECOS PAC ID: 0840477030 Enrollment ID: I20110616000287 |
| Provider Name | Miguel Labrada |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619417656 PECOS PAC ID: 4183059603 Enrollment ID: I20200114001136 |
| Provider Name | Bhavana Janakkumar Patel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528583051 PECOS PAC ID: 1052700267 Enrollment ID: I20211109003045 |
| Provider Name | Louma Sebaihi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588135511 PECOS PAC ID: 2365781143 Enrollment ID: I20220428002168 |
| Provider Name | Emily Jean Burkhardt |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356036297 PECOS PAC ID: 1658733308 Enrollment ID: I20230814001093 |
| Provider Name | Morgan Wright Williams |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1821519901 PECOS PAC ID: 1658714381 Enrollment ID: I20240305002162 |
| Provider Name | Lino Diaz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760092381 PECOS PAC ID: 2466899331 Enrollment ID: I20240327002295 |
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