Primecare at Twin Lakes LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

ME47294 Issued in FL

Legal business name

PRIMECARE AT TWIN LAKES LLC

Practice address

1890 Lpga Blvd
Ste 130
Daytona Beach, FL 32117-7130

Phone

(386) 274-2212

Fax

(386) 274-1508

NPI assigned

May 23, 2005

Last updated

Mar 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Duva, M.D.

Title

President

Phone

(386) 274-7800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Buckley Canalizo, MD

  • Emergency Medicine Physician
  • Orange City, FL
  • NPI 1538116355
  Medicare reassignment Care Compare group NPD
• Monica Edith Cantu, MD

  • General Practice Physician
  • Daytona Beach, FL
  • NPI 1598155830
  Medicare reassignment Care Compare group NPD
• Julia Malysh

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1356075766
  Medicare reassignment Care Compare group NPD
• Tatiana Panea, APRN

  • Family Nurse Practitioner
  • Bristol, CT
  • NPI 1841922952

  FL

  Medicare reassignment Care Compare group NPD
• Rebecca Romack, M.D.

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1619234770

  FL

  Medicare reassignment Care Compare group NPD
• Victoria Hinckley, PA-C

  • Medical Physician Assistant
  • Quincy, MA
  • NPI 1942712294

  FL

  Medicare reassignment Care Compare group
• Wayne Barry, MD

  • Emergency Medicine Physician
  • Orange City, FL
  • NPI 1497794739
  Medicare reassignment NPD
• Janel Irene Coffing, ARNP

  • Nurse Practitioner
  • Daytona Beach, FL
  • NPI 1902356314
  Medicare reassignment NPD
• Jennifer L Fick, PA-C

  • Physician Assistant
  • Daytona Beach, FL
  • NPI 1932182177
  Medicare reassignment NPD
• Kevin Andre Funk, M.D.

  • Family Medicine Physician
  • Palatka, FL
  • NPI 1619938644
  Medicare reassignment NPD
• Regina M George, NP

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1477079036
  Medicare reassignment NPD
• Johnsie Carol Grigg, M.D.

  • Family Medicine Physician
  • Holly Hill, FL
  • NPI 1932102159
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1902809122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "SUITE 130",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-2212",
            "fax_number": "386-274-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "STE 130",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-2212",
            "fax_number": "386-274-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE AT TWIN LAKES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "DUVA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-274-7800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "ME47294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primary Healthcare Alliance Foundation Inc
• Prime Health of Central Florida (Advanced Pediatric Gastroenterology Specialists)
• Primecare Acquisition Family Practice Inc
• Primecare Acquisition Inc (PrimeCare Urgent Care Centers Twin Lakes)
• Primecare at Twin Lakes LLC
• Primecare Family Medicine LLC
• Fay L Prince, RN
• Leeanne Pringle, MS, CCC-SLP
• Professional Radiology Associates PA (Alliance MRI of Florida)
• Professional Surgical Assistants

• Urgent Care Clinic/Center in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Urgent Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; 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.

Verify at the official NPI Registry.