Healthcare Provider Details

I. General information

NPI: 1811980196
Provider Name (Legal Business Name): THE CARITHERS PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 PARK ST
JACKSONVILLE FL
32204-3811
US

IV. Provider business mailing address

2121 PARK ST
JACKSONVILLE FL
32204-3811
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-6200
  • Fax: 904-387-0261
Mailing address:
  • Phone: 904-387-6200
  • Fax: 904-387-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WESTBROOK
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 904-387-9505