MEDICARE: NEMOURS CHILDREN'S HEALTH, LAKE NONA, URGENT 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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1386318350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEMOURS CHILDREN'S HEALTH, LAKE NONA, URGENT 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	:	9368 NARCOOSSEE RD STE 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-5704
Country	:	US
Telephone Number	:	407-332-6113
Fax Number	:

Authorized Official
Title or Position	:	VP, FINANCE
Name	:	RODNEY AARON MCKENDREE
Credential	:
Telephone Number	:	904-697-5648

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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