Active NPI
Afya Med Services LLC
- Family Nurse Practitioner
- Marco Island, FL
National Provider Identifier
1730937871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- AFYA MED SERVICES LLC
- Practice address
- 606 Bald Eagle Dr Ste 616
Marco Island, FL 34145-2781 - Phone
- (239) 601-5452
- NPI assigned
- May 13, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Wakesho Ngondo, APRN
- Title
- Manager
- Phone
- (239) 601-5452
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
606 Bald Eagle Dr Ste 616
Marco Island, FL 34145-2781
Mailing address
606 Bald Eagle Dr Ste 616
Marco Island, FL 34145-2781
Phone (239) 601-5452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240923000233 | FL | Part B Supplier - Clinic/Group Practice | 6901347616 |
Receives reassigned benefits from 3 practitioners Practice locations: Marco Island, FL |
National Provider Directory
National Provider DirectoryLocations
606 Bald Eagle Dr
Ste 616
Marco Island, FL 34145
Phone (239) 601-5452
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715558400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715558400000",
"number": "1730937871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 BALD EAGLE DR STE 616",
"city": "MARCO ISLAND",
"state": "FL",
"postal_code": "341452781",
"telephone_number": "239-601-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 BALD EAGLE DR STE 616",
"city": "MARCO ISLAND",
"state": "FL",
"postal_code": "341452781",
"telephone_number": "239-601-5452"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AFYA MED SERVICES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-05-13",
"last_updated": "2024-05-13",
"certification_date": "2024-05-12",
"status": "A",
"authorized_official_last_name": "NGONDO",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "WAKESHO",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "239-601-5452",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marco Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.