Healthcare Provider Details

I. General information

NPI: 1417861634
Provider Name (Legal Business Name): JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 WHITE EAGLE BLVD
BRADENTON FL
34211-4146
US

IV. Provider business mailing address

501 6TH ST S
ST PETERSBURG FL
33701-4630
US

V. Phone/Fax

Practice location:
  • Phone: 941-309-6550
  • Fax:
Mailing address:
  • Phone: 727-767-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLY KINSLER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 727-767-3407