Awa Primary Care PLLC
Organization Active NPI Primary Care Clinic/Center · Indialantic, FL
NPI 1699523340 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1699523340
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- AWA PRIMARY CARE PLLC
- Practice address
- 97 Niemira Ave Apt E
Indialantic, FL 32903-2936 - Phone
- (407) 579-1616
- Fax
- (855) 642-2122
- NPI assigned
- May 8, 2024
- Organization subpart
- No
Authorized official
- Name
- Arilma Milagros Wong Arjona, NP
- Title
- Ceo
- Phone
- (407) 579-1616
Practitioners 1
-
Arilma Milagros Wong Arjona, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260326002468 | FL | Part B Supplier - Clinic/Group Practice | 5193200277 |
Receives reassigned benefits from 1 practitioner Practice locations: Indialantic, FL |
National Provider Directory
Locations
200 N Palm Ave
Unit 33451
Indialantic, FL 32903
150 Coconut Dr
Ste 101C
Indialantic, FL 32903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
97 Niemira Ave Apt E
Indialantic, FL 32903-2936
Mailing address
200 N Palm Ave Unit 33451
Indialantic, FL 32903-5019
Phone (407) 579-1616
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.