Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Verdure Exclusive PA

Organization Internal Medicine Physician · NPI 1295221711

Verdure Exclusive PA is an Internal Medicine Physician in Port Orange, Florida. Works from 3 locations. Registered with an NPI since 2018.

In the registry since
2018
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4645 Clyde Morris Blvd Ste 404
Port Orange, FL 32129-3005
Phone: (386) 855-8633
Fax: (855) 857-5810
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 12443 San Jose Blvd Ste 204, Jacksonville, FL 32223-8648 — (386) 855-8633
  • 12915 Jones Maltsberger Rd Ste 102, San Antonio, TX 78247-4255 — (386) 855-8633

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1295221711
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tinuade Olusegun — Owner · (386) 855-8633
Other names Angelic Lift; Angelic Lift
NPI enumeratedJuly 9, 2018
Last updated in NPPESDecember 13, 2022
Certification dateDecember 13, 2022
Mailing address4645 Clyde Morris Blvd Ste 404, Port Orange, FL 32129-3005

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