Healthcare Provider Details

I. General information

NPI: 1912604240
Provider Name (Legal Business Name): NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N FEDERAL HWY STE 370
POMPANO BEACH FL
33064-6550
US

IV. Provider business mailing address

PO BOX 947095
ATLANTA GA
30394-7095
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-5731
  • 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: ROBBIN ANDERSON
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 786-624-5747