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NPI Code Detail

MEDICARE: NEMOURS CHILDREN'S HEALTH, WATERFORD LAKES, SPECIALTY CARE

MEDICARE: NEMOURS CHILDREN'S HEALTH, WATERFORD LAKES, SPECIALTY CARE
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1205404761
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEMOURS CHILDREN'S HEALTH, WATERFORD LAKES, SPECIALTY CARE
Provider Business Mailing Address
First Line : 10140 CENTURION PKWY N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-0532
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 651 N ALAFAYA TRL
Second Line :
City : ORLANDO
State : FL
Zip : 32828-7045
Country : US
Telephone Number : 407-650-7715
Fax Number :
Authorized Official
Title or Position : VP, FINANCE
Name : RODNEY AARON MCKENDREE
Credential :
Telephone Number : 904-697-5648
Provider Enumeration Date : 06/11/2021
Last Update Date : 06/22/2021

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Directions to “NEMOURS CHILDREN'S HEALTH, WATERFORD LAKES, SPECIALTY CARE ” Practice Location

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