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Organization
PANACEA ALLIANCE CORP.
Active
Organization
PANACEA ALLIANCE CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENEIDA GOMEZ MD (OWNER)
(904) 342-0672
Entity
Organization
Contact information
Practice address
1750 TREE BLVD, STE 5, ST AUGUSTINE, FL 32084-5715
(904) 342-0672
(904) 342-0673
Mailing address
1750 TREE BLVD STE 5, ST AUGUSTINE, FL 32084-5719
(904) 342-0672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
ME83444
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME 83444
FL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/22/2008
Last updated
04/16/2024
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