| Tradition Health And Wellness Clinic Pllc | |
|
10198 Sw Village Pkwy Ste 105 Port St Lucie FL 34987-2592 | |
| (772) 934-4990 | |
| (772) 934-4991 |
| Full Name | Tradition Health And Wellness Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 10198 Sw Village Pkwy Ste 105, Port St Lucie, Florida |
| Authorized Official Name and Position | Sabrina Lynn Vizzini (CEO) |
| Authorized Official Contact | 7729344990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tradition Health And Wellness Clinic Pllc 10198 Sw Village Pkwy Ste 105 Port St Lucie FL 34987-2592 Ph: (772) 934-4990 | Tradition Health And Wellness Clinic Pllc 10198 Sw Village Pkwy Ste 105 Port St Lucie FL 34987-2592 Ph: (772) 934-4990 |
| NPI Number | 1720840168 |
|---|---|
| Provider Enumeration Date | 01/30/2024 |
| Last Update Date | 04/09/2024 |
| Medicare PECOS PAC ID | 8224477013 |
|---|---|
| Medicare Enrollment ID | O20240412001175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720840168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Emily Gore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659017309 PECOS PAC ID: 3072993229 Enrollment ID: I20220705002928 |
| Provider Name | Roseclaire Darang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033782545 PECOS PAC ID: 9739549569 Enrollment ID: I20230712001668 |
| Provider Name | Brittnee Spooner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447038682 PECOS PAC ID: 1759737711 Enrollment ID: I20231026003309 |
| Provider Name | Stephanie Lynne Hoppy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639563729 PECOS PAC ID: 8426369695 Enrollment ID: I20240124003745 |
| Provider Name | John Hamilton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487034831 PECOS PAC ID: 7911266077 Enrollment ID: I20240418001571 |
| Provider Name | Amy Michelle Weber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730962754 PECOS PAC ID: 0042651333 Enrollment ID: I20240517001206 |
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