Healthcare Provider Details

I. General information

NPI: 1235584160
Provider Name (Legal Business Name): SOUTH FLORIDA PEDIATRIC HOSPITALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17105 GULF PINE CIR
WELLINGTON FL
33414-6354
US

IV. Provider business mailing address

17105 GULF PINE CIR
WELLINGTON FL
33414-6354
US

V. Phone/Fax

Practice location:
  • Phone: 561-445-8203
  • Fax: 561-828-6236
Mailing address:
  • Phone: 561-445-8203
  • Fax: 561-828-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CHRISTEN ANN MARANTE
Title or Position: PRESIDENT
Credential: RN
Phone: 561-445-8203