| |
2140 Kingsley Ave Ste 2 Orange Park FL 32073-5129 | |
(999) 999-9999 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 2140 Kingsley Ave Ste 2, Orange Park, Florida |
Authorized Official Name and Position | John Distefano (BUSINESS MANAGER) |
Authorized Official Contact | 3523173214 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1548 Maple Leaf Ln Fleming Island FL 32003-8225 Ph: (904) 752-0215 | 2140 Kingsley Ave Ste 2 Orange Park FL 32073-5129 Ph: (999) 999-9999 |
NPI Number | 1851146500 |
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Provider Enumeration Date | 04/17/2024 |
Last Update Date | 02/07/2025 |
Medicare PECOS PAC ID | 0143763854 |
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Medicare Enrollment ID | O20240624000289 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851146500 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jessica Lynn Kalarovich |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225526239 PECOS PAC ID: 2860742269 Enrollment ID: I20180905003872 |
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