| 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 | Gloriosa R Antiporda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497775316 PECOS PAC ID: 0042205247 Enrollment ID: I20040417000026 |
| Provider Name | Audrey M Wooten |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962466805 PECOS PAC ID: 2860590148 Enrollment ID: I20070611000293 |
| Provider Name | Vincent H Ober |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669432423 PECOS PAC ID: 2365500055 Enrollment ID: I20081027000011 |
| Provider Name | Shelly H Thompson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821054560 PECOS PAC ID: 6800937228 Enrollment ID: I20100107000595 |
| Provider Name | Natasha N Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437594520 PECOS PAC ID: 4183865645 Enrollment ID: I20130725000240 |
| Provider Name | Ava Phoenix |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205898517 PECOS PAC ID: 7315019205 Enrollment ID: I20131023002326 |
| Provider Name | Faith J Snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467884171 PECOS PAC ID: 5294957411 Enrollment ID: I20141103002288 |
| Provider Name | Mikah C Owen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174886238 PECOS PAC ID: 0042527525 Enrollment ID: I20150916000495 |
| Provider Name | Nikita Mcmiller Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992177349 PECOS PAC ID: 6608176185 Enrollment ID: I20151207000847 |
| 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 | Jau R Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497269880 PECOS PAC ID: 2264790831 Enrollment ID: I20180103002745 |
| Provider Name | Leslie A Barstow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578093142 PECOS PAC ID: 7911267331 Enrollment ID: I20180205000014 |
| Provider Name | Shannon Denise Shea |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053638551 PECOS PAC ID: 7315291556 Enrollment ID: I20181107000919 |
| 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 | Chandroutie Santoo-vazquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740389683 PECOS PAC ID: 0840616843 Enrollment ID: I20200821000455 |
| Provider Name | Judith Hepburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447621420 PECOS PAC ID: 2365855566 Enrollment ID: I20210107001438 |
| Provider Name | Abby Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134719230 PECOS PAC ID: 9638584402 Enrollment ID: I20210209002611 |
| Provider Name | Kendra Seccombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083073365 PECOS PAC ID: 2163728338 Enrollment ID: I20210624001525 |
| Provider Name | Delores Calmese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477708816 PECOS PAC ID: 1456513688 Enrollment ID: I20220104001125 |
| Provider Name | Latasha Yvette Mcclellan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871101691 PECOS PAC ID: 5597144568 Enrollment ID: I20220622000574 |
| 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 |
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