PEDIATRIC INNOVATION CENTER, LLC (NPI# 1457805756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457805756 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC INNOVATION CENTER, LLC |
| Practice Address |
13241 Bartram Park Blvd Suite 209 Jacksonville FL 32258-5212 |
| Practice Telephone | 9046162772 |
| Practice Fax Number | 9046742313 |
| Mailing Telephone | 9046162772 |
| Mailing Fax Number | 9046742313 |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2016-08-04 |
| Authorized Official Name | ASHRAF AFFAN (PRESIDENT) |
| Authorized Official Telephone | 9046162772 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | ME86016 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
13241 BARTRAM PARK BLVD SUITE 209 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32258-5212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306833587 | Mark Andrew Matey | Podiatrist | 13241 Bartram Park Blvd, Suite 1809, Jacksonville, FL 32258-5227 | 2005-10-03 |
| 1942808977 | Etleva Iliazi | Nurse Practitioner | 13241 Bartram Park Blvd, Jacksonville, FL 32258-5212 | 2020-10-12 |
| 1952830093 | Lauren Kessenich | Nurse Practitioner | 13241 Bartram Park Blvd, Jacksonville, FL 32258-5212 | 2017-06-11 |
| 1497295505 | Blayne O Yerby | Physician Assistant | 13241 Bartram Park Blvd, Suite 209, Jacksonville, FL 32258-5212 | 2017-03-08 |
| 1366981904 | Jennifer Mooney | Nurse Practitioner | 13241 Bartram Park Blvd, Suite 209, Jacksonville, FL 32258-5212 | 2017-02-15 |
| 1902344427 | Raquel S Watkins Md Pllc | Allergy & Immunology | 13241 Bartram Park Blvd, Suite 2601, Jacksonville, FL 32258-5212 | 2017-02-03 |
| 1386097442 | Khoi M Le | Dentist | 13241 Bartram Park Blvd, Ste. 1705, Jacksonville, FL 32258-5212 | 2016-07-13 |
| 1629453246 | Julian Bungubung | Nurse Practitioner | 13241 Bartram Park Blvd, Suite 413, Jacksonville, FL 32258-5212 | 2015-07-24 |
| 1023496189 | Railing Chiropractic & Acupuncture | Chiropractor | 13241 Bartram Park Blvd, 509, Jacksonville, FL 32258-5212 | 2015-05-09 |
| 1699170035 | Physicians Group Services Pa | Family Medicine | 13241 Bartram Park Blvd, Suite 1101, Jacksonville, FL 32258-5212 | 2014-10-28 |
| Find all providers in the same location | ||||
| 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 | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396369187 | Im Sulzbacher Center for The Homeless, Inc | Pediatrics | 5455 Springfield Blvd, Jacksonville, FL 32208-5166 | 2020-06-08 |
| 1609334515 | Jeremy N Harris, M.d., P.a. | Pediatrics | 3636 University Blvd S Ste B3, Jacksonville, FL 32216-4223 | 2019-03-10 |
| 1851856975 | Aksharbrahma Pa | Pediatrics | 6100 Greenland Rd Ste 301, Jacksonville, FL 32258-2626 | 2019-02-02 |
| 1184116972 | North Florida Pediatrics, Pa | Pediatrics | 9770 Old Bay Meadows Road, Suite 101, Jacksonville, FL 32256-7986 | 2018-06-06 |
| 1235654781 | Gabriella Assi, Md, LLC | Pediatrics | 5851 Saint Augustine Rd, Jacksonville, FL 32207-8015 | 2017-08-06 |
| 1417478629 | Johana Beatriz Gimenez | Pediatrics | 15 Founders Ln Ste 100, Jacksonville, IL 62650-3924 | 2017-06-28 |
| 1386185932 | Myrna B Ginter | Pediatrics | 3805 Ortega Blvd, Jacksonville, FL 32210-4415 | 2017-03-15 |
| 1831639400 | Children's Health Associates | Pediatrics | 3710 Grandy Ave, Jacksonville, FL 32207-6112 | 2017-03-02 |
| 1770039687 | Hampton Pediatrics Pa | Pediatrics | 11512 Lake Mead Ave Unit 201, Jacksonville, FL 32256-9688 | 2016-08-30 |
| 1447508478 | Starfish Pediatrics Pa | Pediatrics | 4500 Hodges Blvd, Suite 1, Jacksonville, FL 32224-2207 | 2012-08-23 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32258 |
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| 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.