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General NPI Number Information
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NPI Number | 1144627902
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Entity Type | Organization
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Legal Business Name | DAYBREAK PEDIATRIC HOUSECALLS, P.A.
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 925 NORTHSIDE DR
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City | MOUNT DORA
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State | FL
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Zip | 32757-2610
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Country | US
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Telephone | 352-359-2757
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Fax | 866-215-0354
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Provider Business Mailing Address
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Address Line | PO BOX 164
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City | MOUNT DORA
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State | FL
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Zip | 32756-0164
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Country | US
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Telephone | 352-359-2757
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Fax | 866-215-0354
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. APRIL CHRISTINA HAUKOOS
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Credential | ARNP
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Telephone | 352-359-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | ARNP3084852
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License Number State | FL
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