| Pacifica Care Pllc | |
|
13121 Atlantic Blvd Suite 100 Jacksonville FL 32225 | |
| (904) 221-2232 | |
| (904) 221-2205 |
| Full Name | Pacifica Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13121 Atlantic Blvd, Jacksonville, Florida |
| Authorized Official Name and Position | Peggy A Arcanz (ADMINISTRATOR) |
| Authorized Official Contact | 9042212232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacifica Care Pllc 13121 Atlantic Blvd Suite 100 Jacksonville FL 32225 Ph: (904) 221-2232 | Pacifica Care Pllc 13121 Atlantic Blvd Suite 100 Jacksonville FL 32225 Ph: (904) 221-2232 |
| NPI Number | 1669775037 |
|---|---|
| Provider Enumeration Date | 12/07/2010 |
| Last Update Date | 01/10/2012 |
| Medicare PECOS PAC ID | 7911184692 |
|---|---|
| Medicare Enrollment ID | O20110606000563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669775037 | NPI | - | NPPES |
| 292650400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 9102783 (Florida) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | HCC8789 (Florida) | Primary |
| Provider Name | Atul M Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962471169 PECOS PAC ID: 6507850617 Enrollment ID: I20040412001546 |
| Provider Name | Debra D Laclair |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487967949 PECOS PAC ID: 6901920610 Enrollment ID: I20100902000296 |
| Provider Name | Andrew Lister |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992167191 PECOS PAC ID: 6800127820 Enrollment ID: I20200702000101 |
| Provider Name | Anne Goldstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578105003 PECOS PAC ID: 6406271105 Enrollment ID: I20200728003558 |
| Provider Name | Donna Treesh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043298706 PECOS PAC ID: 4789586397 Enrollment ID: I20231006000347 |
| Provider Name | Samantha Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134887250 PECOS PAC ID: 7618310947 Enrollment ID: I20240202003973 |
| Provider Name | Kenneth Hoeck |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952540643 PECOS PAC ID: 5193168847 Enrollment ID: I20240208004710 |
| Provider Name | Polly Price |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699815175 PECOS PAC ID: 6709229354 Enrollment ID: I20240209003900 |
| Provider Name | Anne Esposito |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417603325 PECOS PAC ID: 9234572884 Enrollment ID: I20240209003948 |
| Provider Name | Sonte Pollock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093498792 PECOS PAC ID: 6507209152 Enrollment ID: I20240209003988 |
| Provider Name | Cassie M Mariscal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063760163 PECOS PAC ID: 1355626243 Enrollment ID: I20240212003711 |
| Provider Name | Alexandria Nagel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821571571 PECOS PAC ID: 9234572736 Enrollment ID: I20240212004203 |
| Provider Name | Kellie Garrett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104364348 PECOS PAC ID: 1456794957 Enrollment ID: I20240212004367 |
| Provider Name | Joseph Hamer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003360363 PECOS PAC ID: 8325328552 Enrollment ID: I20240612004561 |
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