Healthcare Provider Details

I. General information

NPI: 1528101557
Provider Name (Legal Business Name): KIDS CARE PEDIATRICS OF NW FL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7552 NAVARRE PKWY UNIT 18
NAVARRE FL
32566-7308
US

IV. Provider business mailing address

4622 SUMMERDALE BLVD
PACE FL
32571
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-4543
  • Fax: 850-936-8543
Mailing address:
  • Phone: 850-995-0169
  • Fax: 850-995-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0075074
License Number StateFL

VIII. Authorized Official

Name: DR. JENNIFER M ZIMMERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-995-0169