| Your Health Primary Care Of Florida, Llc | |
|
1301 Plantation Island Dr S Ste 303b St Augustine FL 32080-3117 | |
| (803) 457-5129 | |
| Not Available |
| Full Name | Your Health Primary Care Of Florida, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1301 Plantation Island Dr S Ste 303b, St Augustine, Florida |
| Authorized Official Name and Position | Matt Staub (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8037308910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Health Primary Care Of Florida, Llc 111 Doctor Cir Columbia SC 29203-6502 Ph: (803) 457-5129 | Your Health Primary Care Of Florida, Llc 1301 Plantation Island Dr S Ste 303b St Augustine FL 32080-3117 Ph: (803) 457-5129 |
| NPI Number | 1659114577 |
|---|---|
| Provider Enumeration Date | 06/18/2024 |
| Last Update Date | 06/18/2024 |
| Medicare PECOS PAC ID | 0143754135 |
|---|---|
| Medicare Enrollment ID | O20241113003454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659114577 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Astrid Clarke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386740595 PECOS PAC ID: 0749383818 Enrollment ID: I20180509001473 |
| Provider Name | Larry Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134504079 PECOS PAC ID: 2961767363 Enrollment ID: I20180606002252 |
| Provider Name | Terri Woodruff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477832475 PECOS PAC ID: 7911178793 Enrollment ID: I20250303002313 |
| Provider Name | Tara Lyn Madden Wells |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013416718 PECOS PAC ID: 4789926908 Enrollment ID: I20250314002035 |
| Provider Name | Maresa Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447862909 PECOS PAC ID: 7719397090 Enrollment ID: I20250314002651 |
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