Healthcare Provider Details

I. General information

NPI: 1801098504
Provider Name (Legal Business Name): EMERALD COAST PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 WOODBINE RD SUITE 1 & 2
PACE FL
32571-8709
US

IV. Provider business mailing address

5834 BERRYHILL RD
MILTON FL
32570-8275
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8087
  • Fax: 850-994-5292
Mailing address:
  • Phone: 850-995-8087
  • Fax: 850-994-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME87749
License Number StateFL

VIII. Authorized Official

Name: MRS. SHARI WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-623-5437