| Space Coast Advanced Practice Consultants Llc | |
|
115 Hickory St Ste 204 Melbourne FL 32904-3505 | |
| (321) 795-7386 | |
| Not Available |
| Full Name | Space Coast Advanced Practice Consultants Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 115 Hickory St Ste 204, Melbourne, Florida |
| Authorized Official Name and Position | Lakeecia Cannion (OWNER) |
| Authorized Official Contact | 3217957386 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Space Coast Advanced Practice Consultants Llc 1838 Wadena St Nw Palm Bay FL 32907-8511 Ph: (321) 795-7386 | Space Coast Advanced Practice Consultants Llc 115 Hickory St Ste 204 Melbourne FL 32904-3505 Ph: (321) 795-7386 |
| NPI Number | 1477177004 |
|---|---|
| Provider Enumeration Date | 05/29/2020 |
| Last Update Date | 05/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477177004 | NPI | - | NPPES |
| 016947100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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