Healthcare Provider Details

I. General information

NPI: 1447218979
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
WEST PALM BEACH FL
33407-2413
US

IV. Provider business mailing address

3828 JONATHANS WAY
BOYNTON BEACH FL
33436-8523
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-6220
  • Fax:
Mailing address:
  • Phone: 561-966-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number906022
License Number StateFL

VIII. Authorized Official

Name: MS. DEBORAH W. MCGRIFF
Title or Position: ADVANCED REGISTERED NURSE PRACTITIO
Credential:
Phone: 561-840-6220