Healthcare Provider Details

I. General information

NPI: 1568549087
Provider Name (Legal Business Name): BABIES AND BEYOND PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 MARINER BLVD
SPRING HILL FL
34609-5691
US

IV. Provider business mailing address

224 MARINER BLVD
SPRING HILL FL
34609-5691
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-9779
  • Fax: 352-666-4723
Mailing address:
  • Phone: 352-686-9779
  • Fax: 352-666-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME58035
License Number StateFL

VIII. Authorized Official

Name: SANDY DOORNBOS
Title or Position: BILLING/CREDENTIALING
Credential:
Phone: 727-816-9427