| Prestige Outpatient Providers, Llc | |
|
2338 Immokalee Rd # 186 Naples FL 34110-1445 | |
| (239) 330-2933 | |
| Not Available |
| Full Name | Prestige Outpatient Providers, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2338 Immokalee Rd # 186, Naples, Florida |
| Authorized Official Name and Position | Oksana Rustamova (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6465171257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Outpatient Providers, Llc 2338 Immokalee Rd # 141 Naples FL 34110-1445 Ph: (239) 330-2933 | Prestige Outpatient Providers, Llc 2338 Immokalee Rd # 186 Naples FL 34110-1445 Ph: (239) 330-2933 |
| NPI Number | 1124599824 |
|---|---|
| Provider Enumeration Date | 12/07/2018 |
| Last Update Date | 12/21/2018 |
| Medicare PECOS PAC ID | 3870929615 |
|---|---|
| Medicare Enrollment ID | O20200214000593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124599824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Majd Alsamman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932112521 PECOS PAC ID: 1052396470 Enrollment ID: I20040621001114 |
| Provider Name | Zubin Pachori |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427214485 PECOS PAC ID: 0042466880 Enrollment ID: I20120809000363 |
| Provider Name | Jonathan W Marsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275795528 PECOS PAC ID: 2567636897 Enrollment ID: I20120921000339 |
| Provider Name | Omar Hussain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437447752 PECOS PAC ID: 5193943793 Enrollment ID: I20140822001868 |
| Provider Name | Brunette Bastien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699150953 PECOS PAC ID: 6800198334 Enrollment ID: I20151230000949 |
| Provider Name | Holly Dagney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215905120 PECOS PAC ID: 0345383758 Enrollment ID: I20160614001901 |
| Provider Name | Genesis G Flanagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396107223 PECOS PAC ID: 4880974617 Enrollment ID: I20161213000721 |
| Provider Name | Frank Michael Elterman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013357185 PECOS PAC ID: 3971817727 Enrollment ID: I20170221002380 |
| Provider Name | Esther Pinter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902315328 PECOS PAC ID: 7416217401 Enrollment ID: I20180213000952 |
| Provider Name | Jessica Lynn Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699250019 PECOS PAC ID: 5294089512 Enrollment ID: I20181126001372 |
| Provider Name | Jessica Arielle Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316420573 PECOS PAC ID: 4880933225 Enrollment ID: I20190304000289 |
| Provider Name | Kimberly Debow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700341450 PECOS PAC ID: 3577803980 Enrollment ID: I20190321002404 |
| Provider Name | Jersy Fleurant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760947287 PECOS PAC ID: 0941543383 Enrollment ID: I20190528001684 |
| Provider Name | Moises Exposito |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013569417 PECOS PAC ID: 4183955420 Enrollment ID: I20191017000561 |
| Provider Name | Jessica Diehl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003432576 PECOS PAC ID: 0941623383 Enrollment ID: I20200702000156 |
| Provider Name | Lisa A. Sikorski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962008433 PECOS PAC ID: 7719390905 Enrollment ID: I20210107001016 |
| Provider Name | Sharifah Maureen Anglade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922693399 PECOS PAC ID: 4880001700 Enrollment ID: I20210322000191 |
| Provider Name | Constantine George Peters |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1114937562 PECOS PAC ID: 9638165434 Enrollment ID: I20210615001584 |
| Provider Name | Ricardo Alberto Alonso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548623242 PECOS PAC ID: 5698012920 Enrollment ID: I20220627003324 |
| Provider Name | Jorge Christien Cruz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710449731 PECOS PAC ID: 8022498328 Enrollment ID: I20220705000744 |
| Provider Name | Watson Camilus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750013157 PECOS PAC ID: 6608258520 Enrollment ID: I20220809000769 |
| Provider Name | Laritza J Reyes Marti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336860857 PECOS PAC ID: 2769855816 Enrollment ID: I20230310001059 |
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