| Panacea Alliance Corp. | |
|
1750 Tree Blvd Ste 5 St Augustine FL 32084-5715 | |
| (904) 342-0672 | |
| (904) 342-0673 |
| Full Name | Panacea Alliance Corp. |
|---|---|
| Speciality | Family Medicine |
| Location | 1750 Tree Blvd, St Augustine, Florida |
| Authorized Official Name and Position | Eneida Gomez (OWNER) |
| Authorized Official Contact | 9043420672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Panacea Alliance Corp. 1750 Tree Blvd Ste 5 St Augustine FL 32084-5719 Ph: (904) 342-0672 | Panacea Alliance Corp. 1750 Tree Blvd Ste 5 St Augustine FL 32084-5715 Ph: (904) 342-0672 |
| NPI Number | 1326298803 |
|---|---|
| Provider Enumeration Date | 09/22/2008 |
| Last Update Date | 04/16/2024 |
| Certification Date | 04/16/2024 |
| Medicare PECOS PAC ID | 6002974235 |
|---|---|
| Medicare Enrollment ID | O20081016000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326298803 | NPI | - | NPPES |
| Provider Name | Eneida Gomez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366431835 PECOS PAC ID: 0446352652 Enrollment ID: I20070219000402 |
| Provider Name | Daniel a Weinberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124291885 PECOS PAC ID: 8729131743 Enrollment ID: I20090807000473 |
| Provider Name | Angelia Lynn Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366866204 PECOS PAC ID: 7517182785 Enrollment ID: I20140701001463 |
| Provider Name | Concepcion Barreto |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1932236601 PECOS PAC ID: 9133411531 Enrollment ID: I20160705001812 |
| Provider Name | Nicole E Trevor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780484196 PECOS PAC ID: 0749706372 Enrollment ID: I20250428001731 |
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