PEDIATRIC CENTER FOR EXCELLENCE, LLC (NPI# 1215434980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1215434980 |
Entity Type | Organization |
Organization Name | PEDIATRIC CENTER FOR EXCELLENCE, LLC |
Practice Address |
13241 Bartram Park Blvd Unit 209 Jacksonville FL 32258-5233 |
Practice Telephone | 9042245437 |
Practice Fax Number | 9046742313 |
Mailing Telephone | 9042245437 |
Mailing Fax Number | 9046742313 |
Enumeration Date | 2018-04-10 |
Last Update Date | 2018-04-10 |
Authorized Official Name | ASHRAF A AFFAN (OWNER) |
Authorized Official Telephone | 9042245437 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 225XP0200X |
Occupational Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
Y | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Street Address |
13241 BARTRAM PARK BLVD UNIT 209 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32258-5233 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831620210 | Rebecca Hamilton | Nurse Practitioner | 13241 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5233 | 2017-03-27 |
1972067791 | Gabriella Gisela Ford | Physician Assistant | 13241 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5233 | 2019-01-25 |
1659871762 | Haley Danae Glasser | Registered Nurse | 13241 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5233 | 2018-02-15 |
1952834574 | Noelle Vann | Psychologist | 13241 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5233 | 2017-04-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
Find all providers in zip 32258 |
Taxonomy Code | 2251P0200X |
Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Classification | Physical Therapist |
Specialization | Pediatrics |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063957298 | Intentional Play, Inc | Physical Therapist | 4712 Marsh Hammock Dr W, Jacksonville, FL 32224-1858 | 2016-12-26 |
1124101415 | Elisabeth Federico | Physical Therapist | 3615 Oak St, Jacksonville, FL 32205-9021 | 2006-10-23 |
1013008838 | All God's Children Therapy Center | Physical Therapist | 500 West Hickory, Jacksonville, AR 72076-3570 | 2006-09-27 |
1750373114 | Eileen C Davies | Physical Therapist | 249 Orange Ave, Jacksonville, FL 32259-4215 | 2005-08-21 |
1467817239 | Gregory Meyer | Physical Therapist | 2701 T P White Dr, Jacksonville, AR 72076-2514 | 2015-12-22 |
1003284316 | Jessica Dailey | Physical Therapist | 12276 San Jose Blvd Ste 508, Jacksonville, FL 32223-8618 | 2015-09-03 |
1558775767 | Jaimie Kuhn Zaharewicz | Physical Therapist | 7749 Normandy Blvd, Suite 147, Jacksonville, FL 32221-7657 | 2014-06-16 |
1124432604 | Meghan Elizabeth Rowey | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4251 | 2014-06-12 |
1144570169 | Melissa Newman | Physical Therapist | 14785 Old Saint Augustine Rd, Jacksonville, FL 32258-2496 | 2012-09-17 |
1073832200 | Rachel West Kempfert | Physical Therapist | 14785 Old Saint Augustine Rd, Jacksonville, FL 32258-2496 | 2010-05-27 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 32258 |
Please comment or provide details below to improve the information on PEDIATRIC CENTER FOR EXCELLENCE, LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.