Organization
BAPTIST AGEWELL PHYSICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH TIBBS (VICE PRESIDENT)
(904) 202-3283
Entity
Organization
Contact information
Practice address
1545 S 14TH ST, FERNANDINA BEACH, FL 32034-3049
(904) 202-4243
(904) 390-7415
Mailing address
PO BOX 746636, ATLANTA, GA 30374-6636
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/07/2025
Last updated
03/03/2026
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