| Agape Community Health Center, Inc. | |
|
120 King St Jacksonville FL 32204-2410 | |
| (904) 760-4904 | |
| (904) 930-4607 |
| Full Name | Agape Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 King St, Jacksonville, Florida |
| Authorized Official Name and Position | Mia L Jones (CEO) |
| Authorized Official Contact | 9042531069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agape Community Health Center, Inc. 120 King St Jacksonville FL 32204-2410 Ph: (904) 760-4904 | Agape Community Health Center, Inc. 120 King St Jacksonville FL 32204-2410 Ph: (904) 760-4904 |
| NPI Number | 1962867762 |
|---|---|
| Provider Enumeration Date | 12/21/2015 |
| Last Update Date | 09/09/2020 |
| Medicare PECOS PAC ID | 3476500695 |
|---|---|
| Medicare Enrollment ID | O20050331000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962867762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | N04000004094 (Florida) | Primary |
| Provider Name | Tonya N Hollinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053366906 PECOS PAC ID: 7517870892 Enrollment ID: I20031112000199 |
| Provider Name | Vincent H Ober |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669432423 PECOS PAC ID: 2365500055 Enrollment ID: I20081027000011 |
| Provider Name | Dedrick M Daniels |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1730402975 PECOS PAC ID: 7810167897 Enrollment ID: I20141209000024 |
| Provider Name | Danielle M Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508187451 PECOS PAC ID: 0244464154 Enrollment ID: I20160301002344 |
| Provider Name | Shaunetra Toler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225576499 PECOS PAC ID: 3274899489 Enrollment ID: I20171103001225 |
| Provider Name | Christopher Deshawn Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972990141 PECOS PAC ID: 2163736117 Enrollment ID: I20181128002949 |
| Provider Name | Joni R Kocher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831557677 PECOS PAC ID: 7012213143 Enrollment ID: I20181206000403 |
| Provider Name | Veronica A Wittman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912449463 PECOS PAC ID: 3678815057 Enrollment ID: I20190506000511 |
| Provider Name | Roman Criollo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699834408 PECOS PAC ID: 7012080690 Enrollment ID: I20200212000284 |
| Provider Name | Wendy Lynn King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336781772 PECOS PAC ID: 4587095286 Enrollment ID: I20200513001749 |
| Provider Name | Kendra Seccombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083073365 PECOS PAC ID: 2163728338 Enrollment ID: I20210624001525 |
| Provider Name | Knetra Pendleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013382126 PECOS PAC ID: 1456719152 Enrollment ID: I20230627002581 |
| Provider Name | Kenya Dennis-cowart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073193868 PECOS PAC ID: 4789045428 Enrollment ID: I20230727004019 |
| Provider Name | Miney Mathews |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447209937 PECOS PAC ID: 8325176597 Enrollment ID: I20250103003385 |
| Provider Name | Faradia Pierre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114538634 PECOS PAC ID: 0345762852 Enrollment ID: I20250313001973 |
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