| Poinciana Medical Clinic | |
|
51 N Doverplum Ave Kissimmee FL 34758-3308 | |
| (407) 572-8862 | |
| (407) 572-8863 |
| Full Name | Poinciana Medical Clinic |
|---|---|
| Speciality | General Practice |
| Location | 51 N Doverplum Ave, Kissimmee, Florida |
| Authorized Official Name and Position | Ivan A Rivera Soler (MD) |
| Authorized Official Contact | 4075728862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poinciana Medical Clinic 51 N Doverplum Ave Kissimmee FL 34758-3308 Ph: (407) 572-8862 | Poinciana Medical Clinic 51 N Doverplum Ave Kissimmee FL 34758-3308 Ph: (407) 572-8862 |
| NPI Number | 1871923037 |
|---|---|
| Provider Enumeration Date | 11/25/2013 |
| Last Update Date | 07/21/2014 |
| Medicare PECOS PAC ID | 3173759834 |
|---|---|
| Medicare Enrollment ID | O20131202001380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871923037 | NPI | - | NPPES |
| 001456400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ACN241 (Florida) | Primary |
| Provider Name | Ivan A Rivera Soler |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1245433861 PECOS PAC ID: 1557355575 Enrollment ID: I20091217000664 |
| Provider Name | Jadira Rose Santos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457790883 PECOS PAC ID: 6002042116 Enrollment ID: I20131120000710 |
| Provider Name | Suhail V Colon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154952810 PECOS PAC ID: 8426488040 Enrollment ID: I20200423000085 |
| Provider Name | Evelina Figueroa Nater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689443293 PECOS PAC ID: 5597118828 Enrollment ID: I20240205001287 |
| Provider Name | Radhaimilda Cuevas Matos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912789355 PECOS PAC ID: 6800232695 Enrollment ID: I20240315000416 |
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