AMMALA CANTRELL (NPI# 1699955617) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699955617 |
| Entity Type | Organization |
| Organization Name | AMMALA CANTRELL |
| Other Organization Name | CANTRELL MEDICAL CLINIC |
| Practice Address |
1370 13th Ave S Suite 216a Jacksonville Beach FL 32250-3230 |
| Mailing Address |
Po Box 50670 Jacksonville Beach FL 32240-0670 |
| Practice Telephone | 9043720208 |
| Practice Fax Number | 9048536559 |
| Mailing Telephone | 9043720208 |
| Mailing Fax Number | 9048536559 |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2012-10-12 |
| Authorized Official Name | AMMALA CANTRELL (PRESIDENT) |
| Authorized Official Telephone | 9046735553 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ME84833 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BC/BS OF FLORIDA | K8204 | 01 |
| Other Name | Type Code |
|---|---|
| CANTRELL MEDICAL CLINIC | Doing Business As Name - Organization |
| Street Address |
1370 13TH AVE S SUITE 216A |
| City | JACKSONVILLE BEACH |
| State | FL |
| Zip Code | 32250-3230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245608496 | Southeastern Management, LLC | Durable Medical Equipment & Medical Supplies | 1370 13th Ave S, Suite 121, Jacksonville Beach, FL 32250-3230 | 2015-09-04 |
| 1891078234 | Baptist Primary Care Inc | Internal Medicine | 1370 13th Ave S, Suite 216a, Jacksonville Beach, FL 32250-3230 | 2011-09-22 |
| 1336476795 | Lyerly Baptist Inc | Psychiatry & Neurology | 1370 13th Ave S, Suite 215, Jacksonville Beach, FL 32250-3230 | 2009-11-05 |
| 1104058874 | Baptist Neurology Inc | Psychiatry & Neurology | 1370 13th Ave S, Suite 215, Jacksonville Beach, FL 32250-3230 | 2009-08-14 |
| 1891821146 | Robert Davies Md Pa | Urology | 1370 13th Ave S, Ste 121, Jacksonville Beach, FL 32250-3230 | 2007-02-23 |
| 1861528101 | Robert Davies | Urology | 1370 13th Ave S, Ste 121, Jacksonville Beach, FL 32250-3230 | 2007-02-23 |
| 1356458228 | Oceanside Pediatrics | Pediatrics | 1370 13th Ave S, Ste 216, Jacksonville Beach, FL 32250-3230 | 2006-08-24 |
| 1730296765 | Ann Vonthron | Pediatrics | 1370 13th Ave S, Ste 216, Jacksonville Beach, FL 32250-3230 | 2006-08-24 |
| 1891802815 | Elena Model-rybakova | Pediatrics | 1370 13th Ave S, Ste 216, Jacksonville Beach, FL 32250-3230 | 2006-08-24 |
| 1285741348 | Barbara O'reilly | Pediatrics | 1370 13th Ave S, Ste. 216, Jacksonville Beach, FL 32250-3230 | 2006-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386129591 | Kelsey Ilene Keimig | Audiologist | 3200 S 3rd Street, Ste 101, Jacksonville, FL 32250 | 2018-10-03 |
| 1225529696 | Turning Tides Eating Disorder Treatment Center, LLC. | Clinic/Center | 4300 Marsh Landings Blvd. #101, Jacksonville Beach, FL 32250 | 2018-05-22 |
| 1528578820 | Dianne Frances Gay | Dental Hygienist | 1144 14th Street North, Jacksonville Beach, FL 32250 | 2017-10-02 |
| 1801324280 | Kailo Nutrition | Dietitian, Registered | 353 B 6th Street South, Jacksonville, FL 32250 | 2017-05-30 |
| 1275985368 | Shankeertha Sundaralingam | Dentist | 3316 3rd St S Ste 101, Jacksonville Beach, FL 32250 | 2016-07-13 |
| 1851777494 | Brooke Worthington Davidson | Audiologist | 1370 13th Ave S Ste 115, Jacksonville Beach, FL 32250 | 2015-08-05 |
| 1689059115 | Jenna Levine | Speech-Language Pathologist | 779 10th Avenue South, Jacksonville Beach, FL 32250 | 2015-07-27 |
| 1790176824 | Olivia Ingram Caswell | Acupuncturist | 2902 Isabella Boulevard, Suite 50, Jacksonville Beach, FL 32250 | 2015-02-11 |
| 1467859033 | Colleen Freeman | Physical Therapist | 1537 Penman Rd, Jacksonville, FL 32250 | 2014-11-26 |
| 1356750012 | Madelyn Jones | Physical Therapist | 1320 Roberts Drive, Jacksonville Beach, FL 32250 | 2014-08-07 |
| Find all providers in zip 32250 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730575788 | Jill Lezaic | Family Medicine | 1300 Marsh Landing Pkwy Ste 104, Jacksonville Beach, FL 32250-2407 | 2015-04-07 |
| 1952337990 | John Calvin Tanner | Family Medicine | 340 16th Ave N Ste A, Jacksonville Beach, FL 32250-4819 | 2006-06-23 |
| 1437136074 | Samuel J. Fern | Family Medicine | 900 Beach Blvd, Credentialing Department, Jacksonville Beach, FL 32250-4368 | 2005-12-26 |
| 1649272295 | Gary Winfield | Family Medicine | 630 Jacksonville Dr, Jacksonville Beach, FL 32250-3814 | 2005-08-12 |
| 1225650484 | Caroline Snelwar | Family Medicine | 2380 3rd St S Ste 1, Jacksonville Beach, FL 32250-8039 | 2020-05-11 |
| 1467916775 | Corporate Health LLC | Family Medicine | 1350 13th Ave S, Jacksonville Beach, FL 32250-3203 | 2019-01-31 |
| 1689189540 | Baptist Primary Care Inc | Family Medicine | 1127 16th Ave S, Jacksonville Beach, FL 32250-3213 | 2017-12-13 |
| 1023522315 | Reliance Medical Associates of Jax LLC | Family Medicine | 630 Jacksonville Dr, Jacksonville Beach, FL 32250-3814 | 2017-11-22 |
| 1386023463 | Jonathan Gonzalez | Family Medicine | 900 Beach Blvd, Jacksonville Beach, FL 32250 | 2015-05-22 |
| 1750659934 | Karin Wakas Stottman | Family Medicine | 1320 Roberts Dr, Jacksonville Beach, FL 32250-3253 | 2011-12-02 |
| Find all providers in JACKSONVILLE BEACH | ||||
| City | JACKSONVILLE BEACH |
| Zip Code | 32250 |
Please comment or provide details below to improve the information on AMMALA CANTRELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.