Healthcare Provider Details

I. General information

NPI: 1912070756
Provider Name (Legal Business Name): NORTH FLORIDA PEDIATRIC ASSOC., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MACLAY BLVD SUITE 102
TALLAHASSEE FL
32312
US

IV. Provider business mailing address

3606 MACLAY BLVD SUITE 102
TALLAHASSEE FL
32312
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-1162
  • Fax: 850-701-2535
Mailing address:
  • Phone: 850-877-1162
  • Fax: 850-701-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM P. SIMMONS JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-877-1162