| Specialized Care Initiative Pllc | |
|
8348 Little Rd Ste 149 New Port Richey FL 34654-4919 | |
| (855) 232-0644 | |
| Not Available |
| Full Name | Specialized Care Initiative Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 8348 Little Rd Ste 149, New Port Richey, Florida |
| Authorized Official Name and Position | Jeffrey Wacksman (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8552320644 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialized Care Initiative Pllc 8348 Little Road Ste 149 New Port Richey FL 34654-4919 Ph: (855) 232-0644 | Specialized Care Initiative Pllc 8348 Little Rd Ste 149 New Port Richey FL 34654-4919 Ph: (855) 232-0644 |
| NPI Number | 1255179743 |
|---|---|
| Provider Enumeration Date | 07/18/2024 |
| Last Update Date | 07/18/2024 |
| Medicare PECOS PAC ID | 2860932647 |
|---|---|
| Medicare Enrollment ID | O20240906003528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255179743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Primary |
| Provider Name | Marc S Berger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861596058 PECOS PAC ID: 4981685005 Enrollment ID: I20040525001709 |
| Provider Name | Peter Arthur Radice |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356339170 PECOS PAC ID: 4486790011 Enrollment ID: I20091012000403 |
| Provider Name | Charles Livingston Suggs |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1497710172 PECOS PAC ID: 5092853101 Enrollment ID: I20091110000733 |
| Provider Name | Christopher A Morrison |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1134150501 PECOS PAC ID: 1153220025 Enrollment ID: I20100706000299 |
| Provider Name | Adrianne M Ridley Payne |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235355074 PECOS PAC ID: 4284872722 Enrollment ID: I20130523000160 |
| Provider Name | Leonne Moient Deravine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245678119 PECOS PAC ID: 5193967545 Enrollment ID: I20130814000261 |
| Provider Name | Viktoriya Rakita |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740613850 PECOS PAC ID: 7214170554 Enrollment ID: I20130905000442 |
| Provider Name | Jennifer R Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609245950 PECOS PAC ID: 2365743747 Enrollment ID: I20151209002727 |
| Provider Name | Cheryl L Bonacquisti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114450483 PECOS PAC ID: 1355615345 Enrollment ID: I20170914000248 |
| Provider Name | Lydia A Hartney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093934093 PECOS PAC ID: 7214151273 Enrollment ID: I20180806000143 |
| Provider Name | Kristina Ann Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649817503 PECOS PAC ID: 1456786383 Enrollment ID: I20200122002211 |
| Provider Name | Lori Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548708282 PECOS PAC ID: 8123454758 Enrollment ID: I20200130000912 |
| Provider Name | Krystal R Parmar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245705318 PECOS PAC ID: 0244584670 Enrollment ID: I20210329001583 |
| Provider Name | Kelli Monnin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003573072 PECOS PAC ID: 0749675775 Enrollment ID: I20220309002584 |
| Provider Name | Heather M Bruneau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376770727 PECOS PAC ID: 4587815246 Enrollment ID: I20220422000411 |
| Provider Name | Desiree Mones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518643311 PECOS PAC ID: 0941656136 Enrollment ID: I20231024003166 |
| Provider Name | Ludonir Sebastiany |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104485606 PECOS PAC ID: 1456735380 Enrollment ID: I20231229001153 |
| Provider Name | Junell C Koberlein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982868865 PECOS PAC ID: 9234301193 Enrollment ID: I20240801004478 |
| Provider Name | Kelsey Nicole Piper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578332789 PECOS PAC ID: 2466984588 Enrollment ID: I20241015000575 |
| Provider Name | Arlyn Olivo Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619714235 PECOS PAC ID: 6406388024 Enrollment ID: I20241021000746 |
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