| Tallahassee Enhanced Care Pa | |
|
4012 Kelcey Ct Ste 203 Tallahassee FL 32308-5986 | |
| (850) 354-8387 | |
| (850) 329-7878 |
| Full Name | Tallahassee Enhanced Care Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 4012 Kelcey Ct Ste 203, Tallahassee, Florida |
| Authorized Official Name and Position | Marino Martinez (PRESIDENT) |
| Authorized Official Contact | 8503548387 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tallahassee Enhanced Care Pa 4012 Kelcey Ct Ste 203 Tallahassee FL 32308-5986 Ph: (850) 354-8387 | Tallahassee Enhanced Care Pa 4012 Kelcey Ct Ste 203 Tallahassee FL 32308-5986 Ph: (850) 354-8387 |
| NPI Number | 1144788332 |
|---|---|
| Provider Enumeration Date | 03/06/2019 |
| Last Update Date | 10/23/2019 |
| Medicare PECOS PAC ID | 5092049296 |
|---|---|
| Medicare Enrollment ID | O20190621000939 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144788332 | NPI | - | NPPES |
| ME110239 | Other | FL | FL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Rashida A Reid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164672655 PECOS PAC ID: 8820137565 Enrollment ID: I20091209000306 |
| Provider Name | Marino A Martinez Vargas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750680856 PECOS PAC ID: 4183893720 Enrollment ID: I20110816000357 |
| Provider Name | Vanessa Gammill Lickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609343698 PECOS PAC ID: 0941534382 Enrollment ID: I20190619000393 |
| Provider Name | Kayla Juszczyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255956934 PECOS PAC ID: 2860802451 Enrollment ID: I20201111000099 |
| Provider Name | Christina Mann Slotter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396339222 PECOS PAC ID: 0143636449 Enrollment ID: I20210311001217 |
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