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Contact Information

SHORELINE MEDICAL GROUP, P.A.
419 BALTZELL AVE
PORT SAINT JOE, FL32456
 Phone: 850-229-8010
 Fax: 850-227-3177
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nephrology

207RN0300X 11 Physician/Internal Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Rural Health

261QR1300X B4[14] Rural Health Clinic
Indicates primary specialty

NPI Profile & details for SHORELINE MEDICAL GROUP PA · (Female)

NPI # 1427160571
Status Active
Credentials
Entity Individual
Enumeration date 08/31/2006
Last updated 12/19/2018 - About 7 years ago
Sole proprietor 1 Not specified
Identifiers
  • FL Medicaid 377827400
  • Other 10-3887 MEDICARE RHC
  • FL Other 377827401 MEDICAID RHC
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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