| Xtreme Natural Body | |
|
534 Park Ave Ste 6 Orange Park FL 32073-3109 | |
| (443) 846-9100 | |
| Not Available |
| Full Name | Xtreme Natural Body |
|---|---|
| Speciality | Clinic/Center |
| Location | 534 Park Ave Ste 6, Orange Park, Florida |
| Authorized Official Name and Position | Yvonne Marie Good (APRN / OWNER) |
| Authorized Official Contact | 4438469100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Xtreme Natural Body 534 Park Ave Ste 6 Orange Park FL 32073-3109 Ph: (904) 999-1363 | Xtreme Natural Body 534 Park Ave Ste 6 Orange Park FL 32073-3109 Ph: (443) 846-9100 |
| NPI Number | 1376260190 |
|---|---|
| Provider Enumeration Date | 10/24/2022 |
| Last Update Date | 03/21/2023 |
| Medicare PECOS PAC ID | 9537533179 |
|---|---|
| Medicare Enrollment ID | O20230321002165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376260190 | NPI | - | NPPES |
| 1316240716 | Medicaid | FL | |
| 9432176 | Other | FL | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Yvonne Good |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316240716 PECOS PAC ID: 9234302027 Enrollment ID: I20171023000654 |
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