MEDICARE: PALM BEACH PEDIATRICS, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	208000000X	Pediatrics Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1528249976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	2000 PALM BEACH LAKES BLVD STE 901
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6506
Country	:	US
Telephone Number	:	561-509-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 BOYNTON BEACH BLVD STE 240
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3586
Country	:	US
Telephone Number	:	561-509-5009
Fax Number	:	561-738-0556

Authorized Official
Title or Position	:	HEAD OF PRACTICE OPERATIONS
Name	:	ELIZABETH LARSEN
Credential	:
Telephone Number	:	319-936-6898

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	12/11/2025

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