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General NPI Number Information
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NPI Number | 1851172019
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Entity Type | Organization
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Legal Business Name | ATLANTIC COVE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1949 NORTHGATE BLVD
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City | SARASOTA
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State | FL
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Zip | 34234-2143
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Country | US
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Telephone | 941-208-3070
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Fax | 941-208-3067
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Provider Business Mailing Address
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Address Line | 5342 CLARK RD # 3072
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City | SARASOTA
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State | FL
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Zip | 34233-3227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | COLLINS EZEUKA
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Credential | M.D.
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Telephone | 818-554-0112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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