| Premier Endocrinology Pllc | |
|
3004 17th St Saint Cloud FL 34769-6011 | |
| (407) 593-2910 | |
| (407) 593-2913 |
| Full Name | Premier Endocrinology Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3004 17th St, Saint Cloud, Florida |
| Authorized Official Name and Position | Theresa Adadzewa Fynn (OWNER) |
| Authorized Official Contact | 4075932910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Endocrinology Pllc 3004 17th St Saint Cloud FL 34769-6011 Ph: (407) 593-2910 | Premier Endocrinology Pllc 3004 17th St Saint Cloud FL 34769-6011 Ph: (407) 593-2910 |
| NPI Number | 1033487426 |
|---|---|
| Provider Enumeration Date | 12/13/2011 |
| Last Update Date | 07/28/2020 |
| Medicare PECOS PAC ID | 9234396326 |
|---|---|
| Medicare Enrollment ID | O20120501000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033487426 | NPI | - | NPPES |
| 12316257 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | ME109189 (Florida) | Primary |
| Provider Name | Theresa Fynn |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1669639266 PECOS PAC ID: 0941479679 Enrollment ID: I20110812000615 |
| Provider Name | Kwame S Ntim |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1194926501 PECOS PAC ID: 6800911801 Enrollment ID: I20130731000053 |
| Provider Name | Dionardo Medina Encarnacion |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972733699 PECOS PAC ID: 7810143393 Enrollment ID: I20131213000358 |
| Provider Name | Yolanda M Palmero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700359734 PECOS PAC ID: 1355680380 Enrollment ID: I20190308000528 |
| Provider Name | Mustafa Kinaan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1548675655 PECOS PAC ID: 2769808872 Enrollment ID: I20200820000494 |
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