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102 Queensland Cir Ponte Vedra FL 32081 | |
| (619) 578-3763 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 102 Queensland Cir, Ponte Vedra, Florida |
| Authorized Official Name and Position | Ivorique Turner (OWNER/MEMBER) |
| Authorized Official Contact | 6195783763 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
102 Queensland Cir Ponte Vedra FL 32081-6063 Ph: (619) 578-3763 | 102 Queensland Cir Ponte Vedra FL 32081 Ph: (619) 578-3763 |
| NPI Number | 1609364884 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 09/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609364884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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