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426 Disston Ave Clermont FL 34711-2633 | |
| (407) 215-4999 | |
| (888) 762-3102 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 426 Disston Ave, Clermont, Florida |
| Authorized Official Name and Position | Viola M Jacob (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3219466864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
426 Disston Ave Clermont FL 34711-2633 Ph: (407) 215-4999 | 426 Disston Ave Clermont FL 34711-2633 Ph: (407) 215-4999 |
| NPI Number | 1174714414 |
|---|---|
| Provider Enumeration Date | 08/01/2007 |
| Last Update Date | 06/11/2013 |
| Medicare PECOS PAC ID | 8820184500 |
|---|---|
| Medicare Enrollment ID | O20071010000592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174714414 | NPI | - | NPPES |
| 280396800 | Medicaid | FL | |
| 43943 | Other | FL | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | ME90116 (Florida) | Primary |
| Provider Name | Viola Jacob |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972597193 PECOS PAC ID: 7012987571 Enrollment ID: I20040730000560 |
| Provider Name | Ana Marques |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477584357 PECOS PAC ID: 1153346176 Enrollment ID: I20051010000387 |
| Provider Name | Doreen D Gall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053650507 PECOS PAC ID: 5698917946 Enrollment ID: I20130815000576 |
| Provider Name | Saliconte Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306564323 PECOS PAC ID: 3870964588 Enrollment ID: I20241120002861 |
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