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General NPI Number Information
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NPI Number | 1659443687
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ALLIANCE OF NW FL
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 204 CENTER ROAD
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City | GULF BREEZE
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State | FL
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Zip | 32561
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Country | US
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Telephone | 850-932-5348
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Fax | 850-932-7740
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Provider Business Mailing Address
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Address Line | 204 CENTER ROAD
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City | GULF BREEZE
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State | FL
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Zip | 32561
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Country | US
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Telephone | 850-932-5348
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Fax | 850-932-7740
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBIN P RENFROE
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Credential | MD
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Telephone | 850-932-5348
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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 | ME66613
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME87800
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP2874202
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License Number State | FL
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