Healthcare Provider Details

I. General information

NPI: 1457920522
Provider Name (Legal Business Name): NEMOURS CHILDREN'S HEALTH, MOSS PARK, PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MOSS PARK RD STE 118
ORLANDO FL
32832-6087
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-237-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT BRIDGES
Title or Position: EVP, OPERATIONS
Credential:
Phone: 904-697-4000