Provider Demographics
NPI:1720615693
Name:EMERALD MEDICAL, LLC
Entity Type:Organization
Organization Name:EMERALD MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ESPINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-307-9840
Mailing Address - Street 1:2160 58TH AVE # 318
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4647
Mailing Address - Country:US
Mailing Address - Phone:772-307-9840
Mailing Address - Fax:786-756-8419
Practice Address - Street 1:6200 20TH ST STE 378
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1014
Practice Address - Country:US
Practice Address - Phone:772-307-9840
Practice Address - Fax:786-756-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17648OtherSTATE OF FLORIDA
FLAPRN11026541OtherSTATE OF FLORIDA
FLME102761OtherSTATE OF FLORIDA LICENSE
FLHCC14445OtherSTATE OF FLORIDA
FLIMH23931OtherSTATE OF FLORIDA
FLMH22729OtherSTATE OF FLORIDA
FLSW15366OtherSTATE OF FLORIDA
FLPA9108369OtherSTATE OF FLORIDA