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1303 Mosley Dr Lynn Haven FL 32444-5625 | |
| (850) 271-5996 | |
| (850) 271-4088 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1303 Mosley Dr, Lynn Haven, Florida |
| Authorized Official Name and Position | Cindy Taylor (BUSINESS MANAGER) |
| Authorized Official Contact | 8502715996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1303 Mosley Dr Lynn Haven FL 32444-5625 Ph: (850) 271-5996 | 1303 Mosley Dr Lynn Haven FL 32444-5625 Ph: (850) 271-5996 |
| NPI Number | 1083867295 |
|---|---|
| Provider Enumeration Date | 10/31/2008 |
| Last Update Date | 04/28/2022 |
| Medicare PECOS PAC ID | 7517098197 |
|---|---|
| Medicare Enrollment ID | O20100625000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083867295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | ME72254 (Florida) | Secondary |
| Provider Name | Maria U Tedtaotao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437264546 PECOS PAC ID: 2365573425 Enrollment ID: I20100706000723 |
| Provider Name | Amanda J Reitmeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457985640 PECOS PAC ID: 9739517939 Enrollment ID: I20200323001656 |
| Provider Name | Samantha Dawn Pate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720613979 PECOS PAC ID: 4486083961 Enrollment ID: I20200403001975 |
| Provider Name | April Page |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821720004 PECOS PAC ID: 9335688043 Enrollment ID: I20240826004256 |
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