# ARDENT FAMILY CARE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225131477
- **Authorized official:** DR. RENATO ASCENSIO ALFONSO M.D. (PRESIDENT)
- **Authorized official phone:** (386) 439-9777

## Contact information

- **Practice address:** 84 PINNACLES DR STE 200, PALM COAST, FL 32164-2324
- **Practice address phone:** (386) 439-9777
- **Practice address fax:** (386) 206-0015
- **Mailing address:** 84 PINNACLES DR STE 200, PALM COAST, FL 32164-2324
- **Mailing address phone:** (386) 439-9777
- **Mailing address fax:** (386) 206-0015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | D049 | FL | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 07/15/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 253950100 | — | FL |