| Pensacola Primary Care Inc | |
|
2120 East Johnson Avenue Suite 103 Pensacola FL 32514-6050 | |
| (850) 494-3965 | |
| (850) 494-3966 |
| Full Name | Pensacola Primary Care Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2120 East Johnson Avenue, Pensacola, Florida |
| Authorized Official Name and Position | Mickey Pickler (VP) |
| Authorized Official Contact | 8505232117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pensacola Primary Care Inc 3 Maryland Farms Suite 250 Brentwood TN 37027-5005 Ph: (800) 661-3365 | Pensacola Primary Care Inc 2120 East Johnson Avenue Suite 103 Pensacola FL 32514-6050 Ph: (850) 494-3965 |
| NPI Number | 1982643169 |
|---|---|
| Provider Enumeration Date | 06/05/2006 |
| Last Update Date | 10/15/2008 |
| Medicare PECOS PAC ID | 6002718343 |
|---|---|
| Medicare Enrollment ID | O20040126000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982643169 | NPI | - | NPPES |
| 261180500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Christopher H Rush |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023003589 PECOS PAC ID: 3678548831 Enrollment ID: I20040831000925 |
| Provider Name | Tonya Lynn Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982673018 PECOS PAC ID: 5991772881 Enrollment ID: I20040910000943 |
| Provider Name | Michael E Kasabian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275527293 PECOS PAC ID: 5698703361 Enrollment ID: I20050803000259 |
| Provider Name | Carla R Tillery |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770501280 PECOS PAC ID: 7214020148 Enrollment ID: I20070907000496 |
| Provider Name | Donna S Judson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447230479 PECOS PAC ID: 2163325739 Enrollment ID: I20080226000119 |
| Provider Name | Rex D Delaune |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194710012 PECOS PAC ID: 7911032339 Enrollment ID: I20100323000945 |
| Provider Name | Joe A Dunn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053307629 PECOS PAC ID: 3476680430 Enrollment ID: I20100422000714 |
| Provider Name | Laura M Barber |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750537007 PECOS PAC ID: 6709074503 Enrollment ID: I20101221000433 |
| Provider Name | Edward Schuka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194712554 PECOS PAC ID: 8022039296 Enrollment ID: I20110927000705 |
| Provider Name | Phillip A Ham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417960162 PECOS PAC ID: 9436322906 Enrollment ID: I20111027000723 |
| Provider Name | Richard Dawson Hawthorne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427355601 PECOS PAC ID: 3072798982 Enrollment ID: I20121114000263 |
| Provider Name | Sarah E Waite |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740597335 PECOS PAC ID: 8628210572 Enrollment ID: I20130806000653 |
| Provider Name | Serda C Hawthorne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659507986 PECOS PAC ID: 5890841134 Enrollment ID: I20140408001284 |
| Provider Name | Tiffany Ramos |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831489806 PECOS PAC ID: 6406075845 Enrollment ID: I20140916002508 |
| Provider Name | Noel D Bondi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518392158 PECOS PAC ID: 1254569585 Enrollment ID: I20141028000396 |
| Provider Name | Jennifer L Haugen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497140768 PECOS PAC ID: 3870804495 Enrollment ID: I20150623000943 |
| Provider Name | Vicki L Hankins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801199781 PECOS PAC ID: 3577744457 Enrollment ID: I20170808001929 |
| Provider Name | Cristina R Denapoles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467971192 PECOS PAC ID: 1456610260 Enrollment ID: I20180123002852 |
| Provider Name | Ashley Weil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417216623 PECOS PAC ID: 2264740752 Enrollment ID: I20200303001936 |
| Provider Name | Sarah Denise Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033711031 PECOS PAC ID: 5698188803 Enrollment ID: I20220719002735 |
| Provider Name | Heather Lynn Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538893250 PECOS PAC ID: 1951786011 Enrollment ID: I20220910000421 |
| Provider Name | Sue-ann-marie Scott Tracy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144956418 PECOS PAC ID: 5092181792 Enrollment ID: I20221020003424 |
| Provider Name | Nikkol Ferris Grinnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962148627 PECOS PAC ID: 7810364007 Enrollment ID: I20221101000026 |
| Provider Name | Amy Jeanette Villachica |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558089920 PECOS PAC ID: 8527439140 Enrollment ID: I20230118002621 |
| Provider Name | Anil Harrison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487656567 PECOS PAC ID: 1052435914 Enrollment ID: I20230224000067 |
| Provider Name | Stephanie A Bello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518727684 PECOS PAC ID: 9335587740 Enrollment ID: I20240404001798 |
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