Flagler Health Primary Care | |
120 Palencia Village Dr Ste 107 St Augustine FL 32095-8553 | |
(904) 819-3200 | |
(904) 819-3201 |
Full Name | Flagler Health Primary Care |
---|---|
Speciality | Family Medicine |
Location | 120 Palencia Village Dr Ste 107, St Augustine, Florida |
Authorized Official Name and Position | John Franks (DELEGATED OFFICIAL) |
Authorized Official Contact | 9048194065 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Flagler Health Primary Care Po Box 3266 St Augustine FL 32085-3266 Ph: (904) 819-4602 | Flagler Health Primary Care 120 Palencia Village Dr Ste 107 St Augustine FL 32095-8553 Ph: (904) 819-3200 |
NPI Number | 1023672573 |
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Provider Enumeration Date | 04/30/2019 |
Last Update Date | 11/20/2020 |
Medicare PECOS PAC ID | 4082973953 |
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Medicare Enrollment ID | O20190729002457 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023672573 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Provider Name | Richard W Townsend |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003885088 PECOS PAC ID: 0547254625 Enrollment ID: I20040412001292 |
Provider Name | Gregory Alan Gibson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1548270630 PECOS PAC ID: 9133201122 Enrollment ID: I20080130000150 |
Provider Name | Moses Muzquiz |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1043223753 PECOS PAC ID: 2769440338 Enrollment ID: I20090209000498 |
Provider Name | Todd James Batenhorst |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1164489845 PECOS PAC ID: 3375677677 Enrollment ID: I20111213000034 |
Provider Name | Monica Tran |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1184856155 PECOS PAC ID: 6901051952 Enrollment ID: I20160222001787 |
Provider Name | Shawn Rene Wells |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336706779 PECOS PAC ID: 3779813365 Enrollment ID: I20190925000075 |
Provider Name | Tristan A Imhof |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1699123968 PECOS PAC ID: 2062708092 Enrollment ID: I20191014002967 |
Provider Name | Aaron Tawes |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972034676 PECOS PAC ID: 9133483860 Enrollment ID: I20200730000643 |
Provider Name | Leopold Kenneth Kretsch |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982136115 PECOS PAC ID: 2860756400 Enrollment ID: I20200925002309 |
Provider Name | Andrew Hogan |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902245103 PECOS PAC ID: 1557677747 Enrollment ID: I20210316000239 |
Provider Name | Carla Defuria |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1235581000 PECOS PAC ID: 0749683308 Enrollment ID: I20210721000110 |
Provider Name | Caitlin Bass |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1841723780 PECOS PAC ID: 1254769680 Enrollment ID: I20210914002151 |
Provider Name | Mark Michaels |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1740546837 PECOS PAC ID: 5193945459 Enrollment ID: I20211210002482 |
Provider Name | Kimberly Elliott |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1588862098 PECOS PAC ID: 7214086602 Enrollment ID: I20220505002378 |
Provider Name | Hongfei Di |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154717551 PECOS PAC ID: 2163722265 Enrollment ID: I20220620001859 |
Provider Name | Heather Brooke Clair |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1669932380 PECOS PAC ID: 1951638352 Enrollment ID: I20220706001347 |
Provider Name | Christine M Krajewski |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407316797 PECOS PAC ID: 7012317381 Enrollment ID: I20220811000408 |
Provider Name | Elizabeth Looney Di |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1568824530 PECOS PAC ID: 3577856970 Enrollment ID: I20221122001189 |
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