| Prohealth Family Physicians | |
|
3100 17th St Saint Cloud FL 34769-6021 | |
| (407) 892-0009 | |
| (407) 892-3285 |
| Full Name | Prohealth Family Physicians |
|---|---|
| Speciality | Family Medicine |
| Location | 3100 17th St, Saint Cloud, Florida |
| Authorized Official Name and Position | John Frederick Wilker (PRESIDENT) |
| Authorized Official Contact | 4078920009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prohealth Family Physicians 3100 17th St Saint Cloud FL 34769-6021 Ph: (407) 892-0009 | Prohealth Family Physicians 3100 17th St Saint Cloud FL 34769-6021 Ph: (407) 892-0009 |
| NPI Number | 1336189190 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 02/06/2023 |
| Medicare PECOS PAC ID | 3274432521 |
|---|---|
| Medicare Enrollment ID | O20040106000234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336189190 | NPI | - | NPPES |
| 34984 | Other | FL | BLUE CROSS BLUE SHEILD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0036943 (Florida) | Primary |
| Provider Name | John Wilker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770540361 PECOS PAC ID: 2466351739 Enrollment ID: I20040107000078 |
| Provider Name | Kimberly R Stein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073600656 PECOS PAC ID: 0244128429 Enrollment ID: I20050331000090 |
| Provider Name | Anthony J Gustitus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801420955 PECOS PAC ID: 8921414632 Enrollment ID: I20210304000062 |
| Provider Name | Lynette Whaley Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003464215 PECOS PAC ID: 9931505708 Enrollment ID: I20210901003504 |
| Provider Name | Luis Joel Rodriguez Maldonado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992420467 PECOS PAC ID: 2163870148 Enrollment ID: I20231201000557 |
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