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General NPI Number Information
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NPI Number | 1366699944
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Entity Type | Organization
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Legal Business Name | ABRAKIDABRA PEDIATRIC CLINIC, LLC
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 8391 OMAHA CIR
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City | SPRING HILL
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State | FL
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Zip | 34606-5157
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Country | US
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Telephone | 352-688-8818
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Fax | 877-487-5705
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Provider Business Mailing Address
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Address Line | 8391 OMAHA CIR
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City | SPRING HILL
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State | FL
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Zip | 34606-5157
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Country | US
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Telephone | 352-688-8818
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Fax | 877-487-5705
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HEATHER RIDDLE
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Credential | A.R.N.P.
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Telephone | 352-688-8818
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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 | 9175935
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License Number State | FL
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