| Crescent Beach Care LLC | |
|
6573 A1a South St Augustine FL 32080 | |
| (904) 342-7363 | |
| (904) 342-7367 |
| Full Name | Crescent Beach Care LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 6573 A1a South, St Augustine, Florida |
| Authorized Official Name and Position | Adrian S. Long (OWNER/MEMBER MANAGED) |
| Authorized Official Contact | 9043427363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Beach Care LLC 6573 A1a South St Augustine FL 32080 Ph: (904) 342-7363 | Crescent Beach Care LLC 6573 A1a South St Augustine FL 32080 Ph: (904) 342-7363 |
| NPI Number | 1033451380 |
|---|---|
| Provider Enumeration Date | 03/25/2013 |
| Last Update Date | 12/04/2025 |
| Certification Date | 12/04/2025 |
| Medicare PECOS PAC ID | 5991945289 |
|---|---|
| Medicare Enrollment ID | O20130710000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033451380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Rezwan Ashdji |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730190042 PECOS PAC ID: 7810999398 Enrollment ID: I20070213000339 |
| Provider Name | Dudley a Baringer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851463731 PECOS PAC ID: 2466466107 Enrollment ID: I20100427000619 |
| Provider Name | Daniel Joseph Donofrio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710090915 PECOS PAC ID: 5092747220 Enrollment ID: I20101115000243 |
| Provider Name | Adrian S Long |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346407962 PECOS PAC ID: 2466620125 Enrollment ID: I20110722000677 |
| Provider Name | Margret Thorhallsdottir |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124298831 PECOS PAC ID: 3375677420 Enrollment ID: I20110810000550 |
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