Organization
CENTERWELL SENIOR PRIMARY CARE FL JV PLLC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE FL JV PLLC
Other names
Conviva Atlantic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE FL JV PLLC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
11900 ATLANTIC BLVD # 1, JACKSONVILLE, FL 32225-2920
(048) 391-0379
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(407) 447-7120
(407) 770-0661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/19/2024
Last updated
12/10/2024
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