Healthcare Provider Details

I. General information

NPI: 1659443687
Provider Name (Legal Business Name): PEDIATRIC ALLIANCE OF NW FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CENTER ROAD
GULF BREEZE FL
32561
US

IV. Provider business mailing address

204 CENTER ROAD
GULF BREEZE FL
32561
US

V. Phone/Fax

Practice location:
  • Phone: 850-932-5348
  • Fax: 850-932-7740
Mailing address:
  • Phone: 850-932-5348
  • Fax: 850-932-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66613
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87800
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP2874202
License Number StateFL

VIII. Authorized Official

Name: DR. ROBIN P RENFROE
Title or Position: OWNER
Credential: MD
Phone: 850-932-5348