| Cdr Health A Tmg Practice | |
|
313 Norton Dr Ste 102b Tallahassee FL 32308-5965 | |
| (850) 202-1005 | |
| (850) 220-4559 |
| Full Name | Cdr Health A Tmg Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 313 Norton Dr Ste 102b, Tallahassee, Florida |
| Authorized Official Name and Position | Tina Vidal-duart (OWNER & DIRECTOR) |
| Authorized Official Contact | 8507387977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cdr Health A Tmg Practice 11740 Sw 80th St Ste 102 Miami FL 33183-4822 Ph: () - | Cdr Health A Tmg Practice 313 Norton Dr Ste 102b Tallahassee FL 32308-5965 Ph: (850) 202-1005 |
| NPI Number | 1144941816 |
|---|---|
| Provider Enumeration Date | 09/09/2022 |
| Last Update Date | 09/06/2023 |
| Medicare PECOS PAC ID | 6103265723 |
|---|---|
| Medicare Enrollment ID | O20240416001716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144941816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Hugh E Vanlandingham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326056706 PECOS PAC ID: 1355477498 Enrollment ID: I20100329000620 |
| Provider Name | Cody A Vanlandingham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417124744 PECOS PAC ID: 9537347141 Enrollment ID: I20110630000494 |
| Provider Name | Vanessa Gammill Lickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609343698 PECOS PAC ID: 0941534382 Enrollment ID: I20190619000393 |
| Provider Name | Renee Marie Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548517956 PECOS PAC ID: 5799003687 Enrollment ID: I20220804003500 |
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