| Innovative Healthy Aging, Llc | |
|
1120 Pinellas Bayway S Ste 105 Tierra Verde FL 33715-1500 | |
| (727) 282-9724 | |
| (727) 317-0043 |
| Full Name | Innovative Healthy Aging, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1120 Pinellas Bayway S Ste 105, Tierra Verde, Florida |
| Authorized Official Name and Position | Teresa Annette Nesbit (NURSE PRACTIONER) |
| Authorized Official Contact | 7272829724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Healthy Aging, Llc 841 2nd Ave S Tierra Verde FL 33715-2249 Ph: (407) 421-6600 | Innovative Healthy Aging, Llc 1120 Pinellas Bayway S Ste 105 Tierra Verde FL 33715-1500 Ph: (727) 282-9724 |
| NPI Number | 1669158929 |
|---|---|
| Provider Enumeration Date | 06/22/2023 |
| Last Update Date | 03/20/2024 |
| Medicare PECOS PAC ID | 2769821487 |
|---|---|
| Medicare Enrollment ID | O20240415001549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669158929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Teresa Cnm Nesbit |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1053303941 PECOS PAC ID: 4486093101 Enrollment ID: I20240415001691 |
Gyenyame Medical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 4th Avenue N, Tierra Verde, FL 33715 Phone: 646-382-2616 |