| Premier Infectious Disease Consultants Llc | |
|
303 N Clyde Morris Blvd Daytona Beach FL 32114-2709 | |
| (636) 333-4500 | |
| Not Available |
| Full Name | Premier Infectious Disease Consultants Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 303 N Clyde Morris Blvd, Daytona Beach, Florida |
| Authorized Official Name and Position | Tanuja Nemani (OWNER) |
| Authorized Official Contact | 6363334500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Infectious Disease Consultants Llc Po Box 290310 Port Orange FL 32129-0310 Ph: (636) 333-4500 | Premier Infectious Disease Consultants Llc 303 N Clyde Morris Blvd Daytona Beach FL 32114-2709 Ph: (636) 333-4500 |
| NPI Number | 1134472087 |
|---|---|
| Provider Enumeration Date | 10/16/2012 |
| Last Update Date | 10/17/2012 |
| Medicare PECOS PAC ID | 4880824192 |
|---|---|
| Medicare Enrollment ID | O20140306001802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134472087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Latoya D Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558404970 PECOS PAC ID: 4688735335 Enrollment ID: I20081212000579 |
| Provider Name | Enitan O Ekwotafia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598904278 PECOS PAC ID: 6800051665 Enrollment ID: I20120628000097 |
| Provider Name | Tanuja N Nemani |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144403403 PECOS PAC ID: 0547454407 Enrollment ID: I20130305000155 |
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