| Manager | |
|
96040 Lofton Square Ct Yulee FL 32097-6347 | |
| (904) 659-2475 | |
| (904) 453-8600 |
| Full Name | Manager |
|---|---|
| Speciality | Clinic/Center |
| Location | 96040 Lofton Square Ct, Yulee, Florida |
| Authorized Official Name and Position | Wendy Kelly (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 5636502158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manager 221 N Hogan St Ste 118 Jacksonville FL 32202-4201 Ph: (904) 659-2475 | Manager 96040 Lofton Square Ct Yulee FL 32097-6347 Ph: (904) 659-2475 |
| NPI Number | 1699487678 |
|---|---|
| Provider Enumeration Date | 12/21/2022 |
| Last Update Date | 03/10/2023 |
| Medicare PECOS PAC ID | 5092180141 |
|---|---|
| Medicare Enrollment ID | O20230404000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699487678 | NPI | - | NPPES |
| Provider Name | Michael A Coulter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194031880 PECOS PAC ID: 0547386021 Enrollment ID: I20100922000790 |
| Provider Name | Pablo M Pella |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1245347004 PECOS PAC ID: 2668453671 Enrollment ID: I20101019000130 |
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