| Prime Life Health Llc | |
|
3411 W Tampa Bay Blvd Tampa FL 33607-6619 | |
| (813) 874-1509 | |
| Not Available |
| Full Name | Prime Life Health Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3411 W Tampa Bay Blvd, Tampa, Florida |
| Authorized Official Name and Position | Orlando Rangel (MANAGER) |
| Authorized Official Contact | 8138741509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Life Health Llc 3411 W Tampa Bay Blvd Tampa FL 33607-6619 Ph: (813) 874-1509 | Prime Life Health Llc 3411 W Tampa Bay Blvd Tampa FL 33607-6619 Ph: (813) 874-1509 |
| NPI Number | 1821869389 |
|---|---|
| Provider Enumeration Date | 01/12/2024 |
| Last Update Date | 01/12/2024 |
| Medicare PECOS PAC ID | 5092153940 |
|---|---|
| Medicare Enrollment ID | O20240410003840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821869389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ramon Suarez Carmona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851778062 PECOS PAC ID: 8729317854 Enrollment ID: I20190913002711 |
| Provider Name | Danny Abdallah Samara |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1740826635 PECOS PAC ID: 4385034487 Enrollment ID: I20211203001791 |
| Provider Name | Lissette Villalobo Crespo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447959366 PECOS PAC ID: 0547625527 Enrollment ID: I20230426001105 |
| Provider Name | Daniel Escalona Escalona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013612720 PECOS PAC ID: 5698130581 Enrollment ID: I20230427003080 |
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