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Appointment Request
We are located at 5651 49th St. N, Saint Petersburg, FL 33709
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Email
*
Your email
*Please note that this is an appointment request, and the office will reach out to confirm.
New Patient?
*
Yes
No
First Name
*
Your answer
Last Name
*
Your answer
Mobile Phone Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
Insurance
*
If your insurance is not listed, please call the office to confirm eligibility. If you wish to be Self-Pay, please select "Self-Pay"
Choose
AARP Medicare Complete HMO
AARP Medicare Complete PPO
Aetna Choice POS
Aetna Commercial
Aetna HMO
Aetna Manage Plan
Aetna MCR PPO
Aetna Open Access
American Postal Workers Union (APWU)
BCBS Anthem PPO
BCBS Blue Medicare Preferred HMO
BCBS Blue Options PPO
BCBS Blue Select
BCBS BlueCare HMO
BCBS Federal Employee PPO
BCBS Network Blue PPO
BCBS of Florida
BCBS Out of State
Cigna Healthcare
Cigna Open Access Plus
Humana Commercial
Humana HMO Premier
Humana Medicare Gold HMO
Humana Medicare PPO
Medicare B Railroad Medicare
Medicare Part A&B
NALC - Cigna Healthcare
OPTIMUM Healthcare Medicare
Self-Pay
UHC COMM Choice
UHC COMM Choice Plus
UHC Dual Complete HMO
UHC Dual Complete PPO
UHC Medicare Advantage PPO
UnitedHealthcare Commercial
UnitedHealthcare Medicare PPO
Other
Preferred Provider
*
Jay Kamath, MD
Nimal Patel, DO
Lina Hernandez Tumaneng, DNP, APRN
Micaella Kantor, MD
Preferred Appointment Date
*
MM
/
DD
/
YYYY
Preferred Appointment Time
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Morning
Afternoon
Evening
Notes
Your answer
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