| Innovacare Florida Physicians, Llc | |
|
1037 S State Road 7 Ste 211 Wellington FL 33414-6139 | |
| (561) 798-3030 | |
| (561) 798-8242 |
| Full Name | Innovacare Florida Physicians, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1037 S State Road 7 Ste 211, Wellington, Florida |
| Authorized Official Name and Position | David Brown (SECRETARY) |
| Authorized Official Contact | 8337028383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovacare Florida Physicians, Llc 425 W Colonial Dr Ste 303 Orlando FL 32804-6863 Ph: (561) 798-3030 | Innovacare Florida Physicians, Llc 1037 S State Road 7 Ste 211 Wellington FL 33414-6139 Ph: (561) 798-3030 |
| NPI Number | 1316694508 |
|---|---|
| Provider Enumeration Date | 03/07/2022 |
| Last Update Date | 01/03/2025 |
| Medicare PECOS PAC ID | 0244611382 |
|---|---|
| Medicare Enrollment ID | O20220720001463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316694508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ariel Fernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639313091 PECOS PAC ID: 7517010564 Enrollment ID: I20090808000107 |
| Provider Name | Tara Stock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639193568 PECOS PAC ID: 4082717749 Enrollment ID: I20091116000106 |
| Provider Name | Mohamed H Gajraj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275539447 PECOS PAC ID: 4183701378 Enrollment ID: I20100317000170 |
| Provider Name | Lisa D Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447294541 PECOS PAC ID: 9436384369 Enrollment ID: I20131031001457 |
| Provider Name | Tara S Keating |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568899961 PECOS PAC ID: 3577790443 Enrollment ID: I20131220001671 |
| Provider Name | Jamie L Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598185472 PECOS PAC ID: 4981825635 Enrollment ID: I20141021001921 |
| Provider Name | Wiledade Augustin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164809257 PECOS PAC ID: 2466763297 Enrollment ID: I20150622000734 |
| Provider Name | Bianca Delaura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194279265 PECOS PAC ID: 0143504282 Enrollment ID: I20170308002724 |
| Provider Name | Sapna Rao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932680022 PECOS PAC ID: 9133469042 Enrollment ID: I20190312002768 |
| Provider Name | Shaunette K Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467090423 PECOS PAC ID: 0547699613 Enrollment ID: I20200413000233 |
| Provider Name | Natasha Destin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184213068 PECOS PAC ID: 7810393444 Enrollment ID: I20210908001064 |
| Provider Name | Julio Castellanos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376021352 PECOS PAC ID: 5597158634 Enrollment ID: I20220212000046 |
| Provider Name | Julie Thornburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306332333 PECOS PAC ID: 6709244254 Enrollment ID: I20230615002281 |
| Provider Name | Joshua Krumenacker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841589280 PECOS PAC ID: 0345486817 Enrollment ID: I20241120001033 |
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