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General NPI Number Information
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NPI Number | 1124190764
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Entity Type | Organization
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Legal Business Name | ISLAND PEDIATRICS OF ISLAMORADA PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 81599 OLD HWY
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City | ISLAMORADA
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State | FL
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Zip | 33036-3711
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Country | US
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Telephone | 305-664-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 81599 OLD HWY
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City | ISLAMORADA
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State | FL
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Zip | 33036-3711
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Country | US
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Telephone | 305-664-3384
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTI BENGTSON BAGNELL
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Credential | MD
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Telephone | 305-664-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME103085
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License Number State | FL
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