| Optumcare Florida Ci, Llc | |
|
2304 Aloma Ave Ste 100 Winter Park FL 32792-3330 | |
| (407) 679-9222 | |
| Not Available |
| Full Name | Optumcare Florida Ci, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2304 Aloma Ave Ste 100, Winter Park, Florida |
| Authorized Official Name and Position | John G. Liethen (SECRETARY) |
| Authorized Official Contact | 9522056262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optumcare Florida Ci, Llc 10051 5th St N Ste 200 St Petersburg FL 33702-2211 Ph: (727) 828-2335 | Optumcare Florida Ci, Llc 2304 Aloma Ave Ste 100 Winter Park FL 32792-3330 Ph: (407) 679-9222 |
| NPI Number | 1720506603 |
|---|---|
| Provider Enumeration Date | 08/31/2017 |
| Last Update Date | 08/19/2019 |
| Medicare PECOS PAC ID | 0840550562 |
|---|---|
| Medicare Enrollment ID | O20180129000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720506603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Roberto S Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700867553 PECOS PAC ID: 2264529981 Enrollment ID: I20071029000055 |
| Provider Name | Nadia Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518281310 PECOS PAC ID: 8527199975 Enrollment ID: I20100628001104 |
| Provider Name | Joel V Abraham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952511917 PECOS PAC ID: 2163600479 Enrollment ID: I20110708000271 |
| Provider Name | Jennifer L Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255683124 PECOS PAC ID: 7315199981 Enrollment ID: I20121205000187 |
| Provider Name | Rudina Priska |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639373962 PECOS PAC ID: 9234220104 Enrollment ID: I20131014000782 |
| Provider Name | Lindsey Newman-dufresne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316213507 PECOS PAC ID: 0749596534 Enrollment ID: I20150824001796 |
| Provider Name | Candy L Gott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316397458 PECOS PAC ID: 0244518975 Enrollment ID: I20161031001097 |
| Provider Name | Sudha Kalva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336396878 PECOS PAC ID: 7911171228 Enrollment ID: I20161209000883 |
| Provider Name | Kristen M Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790237196 PECOS PAC ID: 3274815576 Enrollment ID: I20170121000326 |
| Provider Name | Adam Michael Deyoung |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306292339 PECOS PAC ID: 5092138107 Enrollment ID: I20200708002043 |
| Provider Name | Thomas E Byrne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154388759 PECOS PAC ID: 6103919709 Enrollment ID: I20201123001346 |
| Provider Name | Claudia Danitza Miranda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639598097 PECOS PAC ID: 9537413315 Enrollment ID: I20201207000501 |
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