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General NPI Number Information
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NPI Number | 1912604240
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Entity Type | Organization
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Legal Business Name | NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 4701 N FEDERAL HWY STE 370
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6550
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Country | US
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Telephone | 954-941-5731
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 947095
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City | ATLANTA
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State | GA
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Zip | 30394-7095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | ROBBIN ANDERSON
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Credential |
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Telephone | 786-624-5747
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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 |
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License Number State |
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