Healthcare Provider Details

I. General information

NPI: 1346428661
Provider Name (Legal Business Name): ORMOND PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W. GRANADA BLVD. ST 1
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

725 W. GRANADA BLVD. ST 1
ORMOND BEACH FL
32174
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-2770
  • Fax: 386-673-2760
Mailing address:
  • Phone: 386-673-2770
  • Fax: 386-673-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER MELISSA DANVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-673-2770