Provider Demographics
NPI:1063457273
Name:ACCENT PHYSICIAN SPECIALISTS PA
Entity Type:Organization
Organization Name:ACCENT PHYSICIAN SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DOCKENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-372-9414
Mailing Address - Street 1:4340 W NEWBERRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2557
Mailing Address - Country:US
Mailing Address - Phone:352-372-9414
Mailing Address - Fax:352-271-5393
Practice Address - Street 1:4340 W NEWBERRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2557
Practice Address - Country:US
Practice Address - Phone:352-372-9414
Practice Address - Fax:352-271-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40297OtherBCBS FL
FL276359103Medicaid
FL112807700Medicaid
FL40297OtherBCBS FL