MEDICARE: NEMOURS CHILDREN'S HEALTH, VERO BEACH, SPECIALTY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1245808708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEMOURS CHILDREN'S HEALTH, VERO BEACH, SPECIALTY CARE

Provider Business Mailing Address
First Line	:	10140 CENTURION PKWY N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0532
Country	:	US
Telephone Number	:	904-697-4000
Fax Number	:	904-697-5102

Provider Business Practice Location Address
First Line	:	1155 35TH LN STE 201B
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6537
Country	:	US
Telephone Number	:	407-650-7715
Fax Number	:

Authorized Official
Title or Position	:	VP, FINANCE
Name	:	RODNEY AARON MCKENDREE
Credential	:
Telephone Number	:	904-697-5648

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	06/11/2021

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