Healthcare Provider Details

I. General information

NPI: 1629147228
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 CENTRE POINTE BLVD STE 104
TALLAHASSEE FL
32308-7823
US

IV. Provider business mailing address

1983 CENTRE POINTE BLVD STE 104
TALLAHASSEE FL
32308-7823
US

V. Phone/Fax

Practice location:
  • Phone: 850-656-2006
  • Fax: 850-656-2820
Mailing address:
  • Phone: 850-656-2006
  • Fax: 850-656-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YVETTE MIGNON
Title or Position: PRESIDENT
Credential: MD
Phone: 850-656-2006