| Medical Specialists Of Northeast Florida Pllc | |
|
6428 Beach Blvd Ste 1a Jacksonville FL 32216-2813 | |
| (904) 342-0816 | |
| (904) 342-0553 |
| Full Name | Medical Specialists Of Northeast Florida Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6428 Beach Blvd Ste 1a, Jacksonville, Florida |
| Authorized Official Name and Position | Shriram Marathe (MEMBER) |
| Authorized Official Contact | 9044845176 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Specialists Of Northeast Florida Pllc 6428 Beach Blvd Ste 1a Jacksonville FL 32216-2813 Ph: (904) 475-2039 | Medical Specialists Of Northeast Florida Pllc 6428 Beach Blvd Ste 1a Jacksonville FL 32216-2813 Ph: (904) 342-0816 |
| NPI Number | 1285938936 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 11/10/2022 |
| Medicare PECOS PAC ID | 4587848163 |
|---|---|
| Medicare Enrollment ID | O20110405001104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285938936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | George Camacho |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538154596 PECOS PAC ID: 6406925239 Enrollment ID: I20080520000686 |
| Provider Name | Robin Belcher-howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104292200 PECOS PAC ID: 9537439088 Enrollment ID: I20170717002561 |
| Provider Name | Ebony R Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891293692 PECOS PAC ID: 5294096061 Enrollment ID: I20180719002594 |
| Provider Name | Johnnie Bradley-goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306322656 PECOS PAC ID: 0042561078 Enrollment ID: I20181001002367 |
| Provider Name | Tony David Echols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205327228 PECOS PAC ID: 0941544902 Enrollment ID: I20181130002520 |
| Provider Name | Manuel Gervasio Ruiz Dicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184130916 PECOS PAC ID: 1850729625 Enrollment ID: I20200311000050 |
| Provider Name | Chelie Chenille Toler Buckley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902573256 PECOS PAC ID: 9537565981 Enrollment ID: I20210909002334 |
| Provider Name | Veronica H Bartley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851851554 PECOS PAC ID: 5597141721 Enrollment ID: I20220926002314 |
| Provider Name | Salia Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073294161 PECOS PAC ID: 5991159568 Enrollment ID: I20230930000279 |
| Provider Name | Darlene Burch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083499412 PECOS PAC ID: 4385099597 Enrollment ID: I20231009000492 |
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