Healthcare Provider Details

I. General information

NPI: 1699722751
Provider Name (Legal Business Name): BAPTIST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 SAN JOSE PARK DR
JACKSONVILLE FL
32217-4612
US

IV. Provider business mailing address

PO BOX 31445
TAMPA FL
33631-3445
US

V. Phone/Fax

Practice location:
  • Phone: 904-737-7668
  • Fax: 904-737-1548
Mailing address:
  • Phone: 904-737-7668
  • Fax: 904-737-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN MONROE
Title or Position: MANAGER
Credential:
Phone: 904-737-7668