| Primary Care Of Orange City Llc | |
|
135 E Minnesota Ave Orange City FL 32763-2312 | |
| (386) 316-5439 | |
| Not Available |
| Full Name | Primary Care Of Orange City Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 135 E Minnesota Ave, Orange City, Florida |
| Authorized Official Name and Position | John Croker (CEO) |
| Authorized Official Contact | 3864733553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Of Orange City Llc 341 W Minnesota Ave Orange City FL 32763-2205 Ph: (386) 316-5439 | Primary Care Of Orange City Llc 135 E Minnesota Ave Orange City FL 32763-2312 Ph: (386) 316-5439 |
| NPI Number | 1972249530 |
|---|---|
| Provider Enumeration Date | 05/06/2022 |
| Last Update Date | 06/29/2022 |
| Medicare PECOS PAC ID | 7517232804 |
|---|---|
| Medicare Enrollment ID | O20220712000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972249530 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Tamika Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891363982 PECOS PAC ID: 5698178028 Enrollment ID: I20210722003468 |
| Provider Name | Jonathan Rabusa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073130332 PECOS PAC ID: 4981095833 Enrollment ID: I20220103001442 |
| Provider Name | Alicia Hulsizer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285380352 PECOS PAC ID: 4880071489 Enrollment ID: I20220520001095 |
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