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General NPI Number Information
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NPI Number | 1720615693
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Entity Type | Organization
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Legal Business Name | EMERALD MEDICAL, LLC
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 6200 20TH ST STE 378
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City | VERO BEACH
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State | FL
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Zip | 32966-1014
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Country | US
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Telephone | 772-307-9840
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Fax | 786-756-8419
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Provider Business Mailing Address
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Address Line | 2160 58TH AVE # 318
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City | VERO BEACH
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State | FL
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Zip | 32966-4647
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Country | US
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Telephone | 772-307-9840
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Fax | 786-756-8419
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Authorized Official
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Title or Position | COO
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Name | MS. AMANDA LYNN ESPINAL
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Credential |
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Telephone | 772-307-9840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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