Healthcare Provider Details

I. General information

NPI: 1619339264
Provider Name (Legal Business Name): PEDIATRICIANS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 COUNTY ROAD 44 LEG A STE 2
LEESBURG FL
34788
US

IV. Provider business mailing address

8245 COUNTY ROAD 44 LEG A STE 2
LEESBURG FL
34788-3751
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-3366
  • Fax:
Mailing address:
  • Phone: 352-326-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99391
License Number StateFL

VIII. Authorized Official

Name: MRS. NICKEEY K SALMON
Title or Position: OWNER
Credential: M.D.
Phone: 352-225-1343