| Prevention 305, Inc | |
|
3317 W Gandy Blvd Tampa FL 33611-2931 | |
| (813) 902-8600 | |
| (813) 902-8800 |
| Full Name | Prevention 305, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3317 W Gandy Blvd, Tampa, Florida |
| Authorized Official Name and Position | Patrick Whiteside (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3058128380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prevention 305, Inc 407 Lincoln Rd Ste 6d Miami Beach FL 33139-3023 Ph: (866) 773-7305 | Prevention 305, Inc 3317 W Gandy Blvd Tampa FL 33611-2931 Ph: (813) 902-8600 |
| NPI Number | 1689447336 |
|---|---|
| Provider Enumeration Date | 11/03/2023 |
| Last Update Date | 01/18/2024 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 8325487895 |
|---|---|
| Medicare Enrollment ID | O20240416004070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689447336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | () | Primary |
| Provider Name | Michael Dunn |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1760477442 PECOS PAC ID: 0941486476 Enrollment ID: I20110518000654 |
| Provider Name | Nicole a Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891062071 PECOS PAC ID: 8426212713 Enrollment ID: I20120618000635 |
| Provider Name | James P Desmarais |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922346816 PECOS PAC ID: 3577717099 Enrollment ID: I20130211000375 |
| Provider Name | Terry Y Law |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063828903 PECOS PAC ID: 0446479612 Enrollment ID: I20160622001698 |
| Provider Name | Deborah Nicasio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801422969 PECOS PAC ID: 6800215534 Enrollment ID: I20200930001523 |
| Provider Name | Rodrigo Sabec |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063012938 PECOS PAC ID: 3870905284 Enrollment ID: I20201209000171 |
| Provider Name | Michael Romeo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740860964 PECOS PAC ID: 6002204302 Enrollment ID: I20211019000910 |
| Provider Name | Alexis Micheau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821738287 PECOS PAC ID: 2466849815 Enrollment ID: I20220503002427 |
| Provider Name | Kurtis B Mohr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093955346 PECOS PAC ID: 4082899521 Enrollment ID: I20260430000448 |
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