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4811 Beach Blvd Ste 300 Jacksonville FL 32207-4867 | |
| (470) 292-3820 | |
| (470) 280-9511 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4811 Beach Blvd Ste 300, Jacksonville, Florida |
| Authorized Official Name and Position | Randall L Haupt (EXECUTIVE VICE PRESIDENT, SGI) |
| Authorized Official Contact | 4702923820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10680 Medlock Bridge Rd Ste 101 Johns Creek GA 30097-8420 Ph: (470) 292-3820 | 4811 Beach Blvd Ste 300 Jacksonville FL 32207-4867 Ph: (470) 292-3820 |
| NPI Number | 1316709272 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 10/29/2024 |
| Medicare PECOS PAC ID | 1759723661 |
|---|---|
| Medicare Enrollment ID | O20240523001865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316709272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Elizabeth M Acloque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972191005 PECOS PAC ID: 3274940382 Enrollment ID: I20210407000802 |
| Provider Name | Frank David Curvin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457397382 PECOS PAC ID: 1557321353 Enrollment ID: I20240524000091 |
| Provider Name | Irina Vella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962243030 PECOS PAC ID: 6002342060 Enrollment ID: I20241213001401 |
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