| St.pete Nurse Practitioner, Llc | |
|
33 4th St N Ste 202 Saint Petersburg FL 33701-3806 | |
| (727) 686-8284 | |
| Not Available |
| Full Name | St.pete Nurse Practitioner, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 33 4th St N Ste 202, Saint Petersburg, Florida |
| Authorized Official Name and Position | Jessica Caraballo (PRESIDENT) |
| Authorized Official Contact | 7276868284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St.pete Nurse Practitioner, Llc 4670 Chancellor St Ne Saint Petersburg FL 33703-4345 Ph: (727) 686-8284 | St.pete Nurse Practitioner, Llc 33 4th St N Ste 202 Saint Petersburg FL 33701-3806 Ph: (727) 686-8284 |
| NPI Number | 1720724297 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 05/09/2022 |
| Medicare PECOS PAC ID | 3375926181 |
|---|---|
| Medicare Enrollment ID | O20220811001198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720724297 | NPI | - | NPPES |
| 1437649100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jessica Ann Caraballo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437649100 PECOS PAC ID: 2769729268 Enrollment ID: I20190122002417 |
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