| Island Doctors Intrastate LLC | |
|
100 Arricola Ave Saint Augustine FL 32080-4515 | |
| (904) 825-4368 | |
| (904) 825-9107 |
| Full Name | Island Doctors Intrastate LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Arricola Ave, Saint Augustine, Florida |
| Authorized Official Name and Position | Roy H Hinman (CEO AND PRESIDENT) |
| Authorized Official Contact | 9048254368 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Doctors Intrastate LLC 100 Arricola Ave Saint Augustine FL 32080-4515 Ph: (904) 825-4368 | Island Doctors Intrastate LLC 100 Arricola Ave Saint Augustine FL 32080-4515 Ph: (904) 825-4368 |
| NPI Number | 1568083889 |
|---|---|
| Provider Enumeration Date | 04/27/2020 |
| Last Update Date | 04/27/2020 |
| Certification Date | 04/27/2020 |
| Medicare PECOS PAC ID | 5395161186 |
|---|---|
| Medicare Enrollment ID | O20200811001733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568083889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Jawad S Farhat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114034709 PECOS PAC ID: 1153315551 Enrollment ID: I20040408001606 |
| Provider Name | Frank Michael Alea |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932153525 PECOS PAC ID: 6002806320 Enrollment ID: I20040526001402 |
| Provider Name | Uriel Nazario Vidal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376557223 PECOS PAC ID: 0840230702 Enrollment ID: I20050510000640 |
| Provider Name | Kristine a Rynn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831142330 PECOS PAC ID: 4789615519 Enrollment ID: I20050822001130 |
| Provider Name | Tammy Blankenship |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1285670216 PECOS PAC ID: 3577596832 Enrollment ID: I20050916000161 |
| Provider Name | Lydia Kefalidou |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508833427 PECOS PAC ID: 9335172600 Enrollment ID: I20050916000295 |
| Provider Name | Jennifer S Matthews |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508834631 PECOS PAC ID: 2062437437 Enrollment ID: I20051014000180 |
| Provider Name | Yevsey M Goldberg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831160977 PECOS PAC ID: 5890705289 Enrollment ID: I20060501000060 |
| Provider Name | Linda a Quinn |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437100187 PECOS PAC ID: 2062425077 Enrollment ID: I20060717000064 |
| Provider Name | Paula G Stowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891714564 PECOS PAC ID: 2163424672 Enrollment ID: I20070213000578 |
| Provider Name | Brian Creghan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1023138708 PECOS PAC ID: 8022037308 Enrollment ID: I20070814000064 |
| Provider Name | Roy H Hinman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760595821 PECOS PAC ID: 6204897218 Enrollment ID: I20071003000827 |
| Provider Name | Edward Alan Johnson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760595961 PECOS PAC ID: 9436229341 Enrollment ID: I20080604000495 |
| Provider Name | Sharol a Patterson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124256532 PECOS PAC ID: 7315085065 Enrollment ID: I20091117000586 |
| Provider Name | Zaw Myint |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225295728 PECOS PAC ID: 6507981727 Enrollment ID: I20100913000031 |
| Provider Name | Michael Berry |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083601900 PECOS PAC ID: 2264613173 Enrollment ID: I20110225000393 |
| Provider Name | Charles J Franson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285707828 PECOS PAC ID: 9234116484 Enrollment ID: I20110509000150 |
| Provider Name | Teresa Marie Brennan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154391753 PECOS PAC ID: 5698926269 Enrollment ID: I20121107000267 |
| Provider Name | Ralph D Priddy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497021059 PECOS PAC ID: 4385860956 Enrollment ID: I20140717001717 |
| Provider Name | Gary Enrique Morales-geraldino |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1083998090 PECOS PAC ID: 5799008967 Enrollment ID: I20141218001515 |
| Provider Name | Walter Ang |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558575696 PECOS PAC ID: 6406938844 Enrollment ID: I20150205002138 |
| Provider Name | Pamela Kuloba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861886806 PECOS PAC ID: 1052631983 Enrollment ID: I20150518000750 |
| Provider Name | William D Bermeo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154423267 PECOS PAC ID: 8022322759 Enrollment ID: I20150807015232 |
| Provider Name | Carlos Reyes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992909329 PECOS PAC ID: 9830327667 Enrollment ID: I20151121000046 |
| Provider Name | Marilu Colon |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1295842862 PECOS PAC ID: 2567360878 Enrollment ID: I20160429000245 |
| Provider Name | Robert a Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568514701 PECOS PAC ID: 1557398179 Enrollment ID: I20160720000190 |
| Provider Name | Teodoro Medina |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093852113 PECOS PAC ID: 5890785463 Enrollment ID: I20160720002795 |
| Provider Name | Julie Ann Bom Conselho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356899587 PECOS PAC ID: 2062700552 Enrollment ID: I20161017001720 |
| Provider Name | Gabor Menczelesz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609869833 PECOS PAC ID: 9032147434 Enrollment ID: I20170104001864 |
| Provider Name | Radu a Segal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457445058 PECOS PAC ID: 7810081460 Enrollment ID: I20170222002694 |
| Provider Name | Juan J Pineda Lopez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1104292846 PECOS PAC ID: 7719295666 Enrollment ID: I20170224001501 |
| Provider Name | Zulma Lopez Rivera |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1770991341 PECOS PAC ID: 0941429484 Enrollment ID: I20171118000170 |
| Provider Name | Rosalie Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114467024 PECOS PAC ID: 7416224738 Enrollment ID: I20180424000863 |
| Provider Name | Luis Marrero Abascal |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1326209073 PECOS PAC ID: 2769609510 Enrollment ID: I20180821001144 |
| Provider Name | Eric Frances Thoms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932201944 PECOS PAC ID: 5294008041 Enrollment ID: I20181029001942 |
| Provider Name | Marilyn Llavona-suarez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1154586972 PECOS PAC ID: 1557614930 Enrollment ID: I20181101001113 |
| Provider Name | Odelaisys Enriquez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1164916615 PECOS PAC ID: 4385980333 Enrollment ID: I20190111000784 |
| Provider Name | Juan Santiago |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1518930155 PECOS PAC ID: 5092051904 Enrollment ID: I20190115000956 |
| Provider Name | Alexa Wu-chavez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1457334757 PECOS PAC ID: 5991718033 Enrollment ID: I20190507000085 |
| Provider Name | Brittney Alise Walden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912469230 PECOS PAC ID: 8325372600 Enrollment ID: I20190619002764 |
| Provider Name | Kathy D Bass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609435239 PECOS PAC ID: 2062741598 Enrollment ID: I20190909004207 |
| Provider Name | Alex Ramon Taveras-cruz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780645903 PECOS PAC ID: 4789652363 Enrollment ID: I20200211000929 |
| Provider Name | Erick Ortega Perez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881994267 PECOS PAC ID: 1557671492 Enrollment ID: I20200327000695 |
| Provider Name | Lee William Elgin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740796770 PECOS PAC ID: 8022367671 Enrollment ID: I20200505001817 |
| Provider Name | Sara Marie Ocampo Denslow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669092110 PECOS PAC ID: 0749601664 Enrollment ID: I20200602000898 |
| Provider Name | Michael Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740741495 PECOS PAC ID: 1557783636 Enrollment ID: I20200618000077 |
| Provider Name | Dalila Fernandez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1568028488 PECOS PAC ID: 7517377229 Enrollment ID: I20201109002583 |
| Provider Name | David Robert Skaggs |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316268311 PECOS PAC ID: 0446573794 Enrollment ID: I20201113001356 |
| Provider Name | Felicia Kavalec |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992310585 PECOS PAC ID: 0446664577 Enrollment ID: I20210201000029 |
| Provider Name | Alexandra Feliz Camilo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1346807625 PECOS PAC ID: 8123431368 Enrollment ID: I20210225000616 |
| Provider Name | Felix M Mckenzie |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1578660874 PECOS PAC ID: 7517121379 Enrollment ID: I20210401000467 |
| Provider Name | Luis Antonio Moreno |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1538372958 PECOS PAC ID: 6507267473 Enrollment ID: I20210629003058 |
| Provider Name | Luis F Cordero Segundo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1922204478 PECOS PAC ID: 7517221419 Enrollment ID: I20211020003261 |
| Provider Name | Robin Carr |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1780341669 PECOS PAC ID: 3577953660 Enrollment ID: I20211203001240 |
| Provider Name | Leslie Colombani |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1205951175 PECOS PAC ID: 9638561715 Enrollment ID: I20220122000163 |
| Provider Name | Canice Chukwuocha |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1376151472 PECOS PAC ID: 5395154447 Enrollment ID: I20221215000922 |
| Provider Name | Olga a Prosvetova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568198026 PECOS PAC ID: 5890169080 Enrollment ID: I20230330001581 |
| Provider Name | Emmanuel Alejandro Garcia Lopez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841725389 PECOS PAC ID: 7719344134 Enrollment ID: I20230530003364 |
| Provider Name | Stephanie Concepcion |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114137510 PECOS PAC ID: 3072827997 Enrollment ID: I20230627002211 |
| Provider Name | Colby Lane Eisenbach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982068045 PECOS PAC ID: 7911291356 Enrollment ID: I20230824000866 |
| Provider Name | David Riascos |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053092221 PECOS PAC ID: 4688028541 Enrollment ID: I20230926002251 |
| Provider Name | Edel Herranz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891495453 PECOS PAC ID: 1254789878 Enrollment ID: I20231121000311 |
| Provider Name | Dennis Arcangel Aglipay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740990712 PECOS PAC ID: 5597115873 Enrollment ID: I20231228002970 |
| Provider Name | Estavelie Meristil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538940317 PECOS PAC ID: 3173062734 Enrollment ID: I20240827001917 |
| Provider Name | Linda M Soliz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437977048 PECOS PAC ID: 4880120146 Enrollment ID: I20241210001664 |
| Provider Name | Shardul Koppar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942756895 PECOS PAC ID: 6507293875 Enrollment ID: I20250114004109 |
| Provider Name | Kia Ayana Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437991452 PECOS PAC ID: 8527598200 Enrollment ID: I20250211000824 |
| Provider Name | Mojisola Oyibo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356045280 PECOS PAC ID: 5698133916 Enrollment ID: I20250211002020 |
| Provider Name | Tiffany K Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386476364 PECOS PAC ID: 4385174895 Enrollment ID: I20250213002078 |
| Provider Name | Michelle L Casto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578937843 PECOS PAC ID: 0244528651 Enrollment ID: I20250326004095 |
| Provider Name | Juan Cortinas-galvan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295239283 PECOS PAC ID: 6709302342 Enrollment ID: I20250428002021 |
| Provider Name | Tausha Charae Mcclain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982406385 PECOS PAC ID: 0345766499 Enrollment ID: I20250501000859 |
| Provider Name | Arthur Vezikov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447049929 PECOS PAC ID: 1759809676 Enrollment ID: I20250514003794 |
| Provider Name | Brandy Lemon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558169656 PECOS PAC ID: 1355869025 Enrollment ID: I20250516000256 |
| Provider Name | Eddah Kinyua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508539271 PECOS PAC ID: 4981094463 Enrollment ID: I20250721000512 |
| Provider Name | Mayralis Enamorado |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1457107484 PECOS PAC ID: 8527501600 Enrollment ID: I20250807002534 |
| Provider Name | Hannah Ogechi Ephraim |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841174745 PECOS PAC ID: 6709384746 Enrollment ID: I20250809000211 |
| Provider Name | Hayley Alyssa Reeves |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376373407 PECOS PAC ID: 2668971425 Enrollment ID: I20250819000337 |
| Provider Name | Santos Ramos Davila |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1982581476 PECOS PAC ID: 7517457633 Enrollment ID: I20251106004509 |
| Provider Name | Hector Villanueva |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1104575380 PECOS PAC ID: 1052853710 Enrollment ID: I20260206002031 |
Medical Professionals of North Florida Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1301 Plantation Island Dr S, Suite 106a, Saint Augustine, FL 32080 Phone: 904-460-9191 |
Get Well, LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Nature Walk Pkwy, Suite 101, Saint Augustine, FL 32092 Phone: 904-217-7030 |
St Johns Menendez Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 580 State Road 206 W, Saint Augustine, FL 32086 Phone: 904-671-8337 |
Bailey Spine & Wellness, LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 224 Southpark Cir E, Saint Augustine, FL 32086 Phone: 904-342-4941 Fax: 904-342-4937 |
Ashfaq Kudia, M.D., P.A. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1301 Plantation Island Dr S Ste 302a, Saint Augustine, FL 32080 Phone: 904-461-9330 Fax: 904-461-9331 |
Michael P. Tessler MD Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 232 Southpark Cir E, Saint Augustine, FL 32086 Phone: 904-829-2141 Fax: 904-829-2141 |