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NPI Code Detail

MEDICARE: ABRAKIDABRA PEDIATRIC CLINIC, LLC

MEDICARE: ABRAKIDABRA PEDIATRIC CLINIC, LLC
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
1208000000XPediatrics Physician9175935FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

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