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General NPI Number Information
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NPI Number | 1962226381
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Entity Type | Organization
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Legal Business Name | AVE MARIA PRIMARY CARE, LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 5080 ANNUNCIATION CIR UNIT 103
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City | AVE MARIA
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State | FL
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Zip | 34142-9655
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Country | US
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Telephone | 239-322-0917
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Fax | 239-658-5143
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Provider Business Mailing Address
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Address Line | 5080 ANNUNCIATION CIR UNIT 103
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City | AVE MARIA
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State | FL
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Zip | 34142-9655
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Country | US
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Telephone | 239-322-0917
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Fax | 239-658-5143
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROLINA MENA
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Credential |
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Telephone | 239-322-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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