| Flagler Family Nursing Home Care Llc | |
|
130 Healthpark Blvd St Augustine FL 32086-5776 | |
| (904) 826-3469 | |
| (904) 679-3169 |
| Full Name | Flagler Family Nursing Home Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 130 Healthpark Blvd, St Augustine, Florida |
| Authorized Official Name and Position | Christopher Zub (AUTHORIZED OFFICIAL/PARTNER) |
| Authorized Official Contact | 9048263469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Flagler Family Nursing Home Care Llc 130 Healthpark Blvd St Augustine FL 32086-5776 Ph: (904) 826-3469 | Flagler Family Nursing Home Care Llc 130 Healthpark Blvd St Augustine FL 32086-5776 Ph: (904) 826-3469 |
| NPI Number | 1679172779 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 10/20/2020 |
| Medicare PECOS PAC ID | 4486063120 |
|---|---|
| Medicare Enrollment ID | O20210510000145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679172779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Frederick Chaz Dolgin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184681876 PECOS PAC ID: 3577538586 Enrollment ID: I20040901000497 |
| Provider Name | Mary K Schupp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851445860 PECOS PAC ID: 0840210969 Enrollment ID: I20051202000635 |
| Provider Name | Carlos M Sanchez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922042191 PECOS PAC ID: 4284719980 Enrollment ID: I20080305000229 |
| Provider Name | Michael Look |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861677601 PECOS PAC ID: 9032282967 Enrollment ID: I20080724000774 |
| Provider Name | Warren Owen Whitlock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538126156 PECOS PAC ID: 0143295154 Enrollment ID: I20100429000316 |
| Provider Name | Linda Sue Clonch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487611166 PECOS PAC ID: 3476685074 Enrollment ID: I20100716000809 |
| Provider Name | Christopher Joseph Zub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972560506 PECOS PAC ID: 5092849307 Enrollment ID: I20100820000995 |
| Provider Name | Myragrace J Golmayo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548545361 PECOS PAC ID: 6507025988 Enrollment ID: I20120302000624 |
| Provider Name | Melissa M Senior |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518224443 PECOS PAC ID: 5597929489 Enrollment ID: I20120605000364 |
| Provider Name | Joann T Fritsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033380126 PECOS PAC ID: 4284795592 Enrollment ID: I20130919000715 |
| Provider Name | Suzanne S Weed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497154520 PECOS PAC ID: 5294956736 Enrollment ID: I20141024002135 |
| Provider Name | Jodie Calain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912135492 PECOS PAC ID: 9830355148 Enrollment ID: I20160920002665 |
| Provider Name | Milena Jguenti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932147402 PECOS PAC ID: 9335154327 Enrollment ID: I20170901002750 |
| Provider Name | Katelyn Raulerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902467095 PECOS PAC ID: 5092041830 Enrollment ID: I20190731002220 |
| Provider Name | Teri Ann Lavenbarg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932232121 PECOS PAC ID: 4385531128 Enrollment ID: I20200210000188 |
| Provider Name | Andrea Tschannerl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164191961 PECOS PAC ID: 6800294620 Enrollment ID: I20211008001948 |
| Provider Name | Andrew H Lourens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568956456 PECOS PAC ID: 2860745965 Enrollment ID: I20230815002719 |
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