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General NPI Number Information
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NPI Number | 1134415227
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Entity Type | Organization
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Legal Business Name | LIGHTS OUT PEDIATRICS LLC
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 3383 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-2461
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Country | US
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Telephone | 352-678-3100
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Fax | 352-678-3730
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Provider Business Mailing Address
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Address Line | 3383 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-2461
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Country | US
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Telephone | 352-678-3100
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Fax | 352-678-3730
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | HEATHER ANN RIDDLE
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Credential | ARNP
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Telephone | 352-678-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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