Healthcare Provider Details

I. General information

NPI: 1073821674
Provider Name (Legal Business Name): SUN COUNTRY PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ANTILLES LN
SPRING HILL FL
34606-4506
US

IV. Provider business mailing address

1221 ANTILLES LN
SPRING HILL FL
34606-4506
US

V. Phone/Fax

Practice location:
  • Phone: 352-678-5246
  • Fax: 352-835-7900
Mailing address:
  • Phone: 352-678-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS10247
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL GRIFFEN
Title or Position: OWNER
Credential: DO
Phone: 352-678-5246