| Sunshine Family Medical Center | |
|
3955 58th St N St Petersburg FL 33709-6003 | |
| (727) 347-2557 | |
| (904) 429-4188 |
| Full Name | Sunshine Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 3955 58th St N, St Petersburg, Florida |
| Authorized Official Name and Position | Roxene Riles (OWNER) |
| Authorized Official Contact | 9044294188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunshine Family Medical Center 3955 58th St N St Petersburg FL 33709-6003 Ph: (727) 347-2557 | Sunshine Family Medical Center 3955 58th St N St Petersburg FL 33709-6003 Ph: (727) 347-2557 |
| NPI Number | 1437700044 |
|---|---|
| Provider Enumeration Date | 09/25/2019 |
| Last Update Date | 11/13/2023 |
| Medicare PECOS PAC ID | 1951733039 |
|---|---|
| Medicare Enrollment ID | O20191111001657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437700044 | NPI | - | NPPES |
| PENDING | Other | FL | FL HF MEDICARE |
| PENDING | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Roxene S Riles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518416510 PECOS PAC ID: 8628357035 Enrollment ID: I20161107002329 |
| Provider Name | Johanna Jovanovic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891400693 PECOS PAC ID: 1951774009 Enrollment ID: I20230310001358 |
| Provider Name | Gissele M Wainscott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386408920 PECOS PAC ID: 5991146698 Enrollment ID: I20240513001978 |
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