| Primary Care Of Oc Llc | |
|
135 E Minnesota Ave Orange City FL 32763-2312 | |
| (386) 316-5439 | |
| (833) 671-1039 |
| Full Name | Primary Care Of Oc Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 135 E Minnesota Ave, Orange City, Florida |
| Authorized Official Name and Position | Valma Croker (CEO) |
| Authorized Official Contact | 3862148047 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Of Oc Llc 341 W Minnesota Ave Orange City FL 32763-2205 Ph: () - | Primary Care Of Oc Llc 135 E Minnesota Ave Orange City FL 32763-2312 Ph: (386) 316-5439 |
| NPI Number | 1790541456 |
|---|---|
| Provider Enumeration Date | 02/21/2024 |
| Last Update Date | 02/21/2024 |
| Medicare PECOS PAC ID | 2062850258 |
|---|---|
| Medicare Enrollment ID | O20240408001021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790541456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | John Croker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518927763 PECOS PAC ID: 2466353412 Enrollment ID: I20040114000334 |
| Provider Name | Paul Bond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497108716 PECOS PAC ID: 5698034759 Enrollment ID: I20180117002086 |
| Provider Name | Dmitriy Shishkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891230371 PECOS PAC ID: 1557626991 Enrollment ID: I20180605002880 |
| Provider Name | Mary Frances Riggins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821584483 PECOS PAC ID: 8527304591 Enrollment ID: I20190111001318 |
| Provider Name | Jonathan Rabusa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073130332 PECOS PAC ID: 4981095833 Enrollment ID: I20220103001442 |
| Provider Name | Alicia Hulsizer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285380352 PECOS PAC ID: 4880071489 Enrollment ID: I20220520001095 |
| Provider Name | Shantoria Lashawn Cooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881370864 PECOS PAC ID: 4981052503 Enrollment ID: I20231121000361 |
| Provider Name | Michaela Slover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184495939 PECOS PAC ID: 7012358427 Enrollment ID: I20240516002271 |
| Provider Name | Mekeshia Shanquietta Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548000789 PECOS PAC ID: 8325580111 Enrollment ID: I20240607002528 |
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