MEDICARE: FLIP FLOPS AND LOLLIPOPS PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	66488	GA
2	261QP2300X	Primary Care Clinic/Center	OS 10686	FL

General Provider Information

NPI Number	:	1013443423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLIP FLOPS AND LOLLIPOPS PEDIATRICS

Provider Business Mailing Address
First Line	:	22455 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-572-1884
Fax Number	:	904-491-1118

Provider Business Practice Location Address
First Line	:	22455 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-572-1884
Fax Number	:	904-491-1118

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. LERA LIV FINA
Credential	:	DO
Telephone Number	:	904-572-1884

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	08/20/2021

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