MEDICARE: CRESCENT BEACH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033451380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT BEACH CARE LLC

Provider Business Mailing Address
First Line	:	6573 A1A SOUTH
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-342-7363
Fax Number	:	904-342-7367

Provider Business Practice Location Address
First Line	:	6573 A1A SOUTH
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-342-7363
Fax Number	:	904-342-7367

Authorized Official
Title or Position	:	OWNER/MEMBER MANAGED
Name	:	DR. ADRIAN S. LONG
Credential	:	MD
Telephone Number	:	904-342-7363

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	12/04/2025

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Directions to “CRESCENT BEACH CARE LLC ” Practice Location

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