MEDICARE: ADVANCED CARE PEDIATRICS OF FLORIDA, 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	261QM3000X	Medically Fragile Infants and Children Day Care

General Provider Information

NPI Number	:	1568293983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE PEDIATRICS OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	3451 SW DARWIN BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3873
Country	:	US
Telephone Number	:	772-321-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 LITTLE RD STE 102
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5403
Country	:	US
Telephone Number	:	772-321-1963
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL PPEC ADMINISTRATOR
Name	:	CRISTOL THERIEN-DOUGLAS
Credential	:	RN
Telephone Number	:	772-321-1963

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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