| Bayfront Hma Wellness Center, Llc | |
|
603 7th St S Suite 350 St Petersburg FL 33701-4719 | |
| (727) 553-7474 | |
| (727) 553-7472 |
| Full Name | Bayfront Hma Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 603 7th St S, St Petersburg, Florida |
| Authorized Official Name and Position | Steven E Clifton (SENIOR VP & GENERAL COUNSEL) |
| Authorized Official Contact | 2395983131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayfront Hma Wellness Center, Llc 5811 Pelican Bay Blvd Suite 500 Naples FL 34108-2733 Ph: () - | Bayfront Hma Wellness Center, Llc 603 7th St S Suite 350 St Petersburg FL 33701-4719 Ph: (727) 553-7474 |
| NPI Number | 1962842963 |
|---|---|
| Provider Enumeration Date | 07/05/2013 |
| Last Update Date | 07/12/2013 |
| Medicare PECOS PAC ID | 3173889102 |
|---|---|
| Medicare Enrollment ID | O20171108001240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962842963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Andrea A Polley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861508392 PECOS PAC ID: 1254523665 Enrollment ID: I20101004001060 |
| Provider Name | Israel B Wojnowich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508165390 PECOS PAC ID: 9436323359 Enrollment ID: I20111110000572 |
| Provider Name | Nicole Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164966743 PECOS PAC ID: 1951684281 Enrollment ID: I20170213001179 |
| Provider Name | Antwan Edward Lacy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477059376 PECOS PAC ID: 5294085924 Enrollment ID: I20180830000823 |
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