Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2026-01-08
- Last updated
- 2026-01-08
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 2146 S RIVERSIDE DR STE 5
- City
- EDGEWATER FL
- Postal code
- 321414257
- Phone
- 386-222-0210
Organization contact
- Name
- OLIVIA EVANS
- Title
- Owner
- Phone
- 3862220210
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.