MEDICARE: DREAM PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1659168516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	2255 DUNN AVE STE 503
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4742
Country	:	US
Telephone Number	:	904-521-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 DUNN AVE STE 503
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4742
Country	:	US
Telephone Number	:	904-521-7564
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TATIANNA MILES
Credential	:
Telephone Number	:	904-868-8923

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/30/2025

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Directions to “DREAM PRIMARY CARE LLC ” Practice Location

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