Provider Demographics
NPI:1386723005
Name:INDEPENDENT PEDIATRICIANS OF NORTH FL INC
Entity type:Organization
Organization Name:INDEPENDENT PEDIATRICIANS OF NORTH FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:904-493-9702
Mailing Address - Street 1:4051 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2036
Mailing Address - Country:US
Mailing Address - Phone:904-493-9702
Mailing Address - Fax:904-493-9700
Practice Address - Street 1:4051 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2036
Practice Address - Country:US
Practice Address - Phone:904-493-9702
Practice Address - Fax:904-493-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56953173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271318700Medicaid
FL273107000Medicaid
FL277263903Medicaid
FL042374200Medicaid
FL273661600Medicaid
FLME92233OtherME LICENSE
FL055661101Medicaid
FLME57974OtherME LICENSE
FL260365900Medicaid
FL277393700Medicaid
FLARNP3253072OtherLICENSE
FLME100160OtherME LICENSE
FLME44431OtherME LICENSE
FL277263900Medicaid
FLME32409OtherME LICENSE
FLME56953OtherME LICENSE
FLME63783OtherME LICENSE
FLME91195OtherME LICENSE
FL277263904Medicaid
FL277263905Medicaid
FL306870600Medicaid
FLARNP9180604OtherLICENSE
FLME38917OtherME LICENSE
FLME55120OtherME LICENSE
FLME6612OtherME LICENSE
FL066208900Medicaid
FL1285741348OtherO'RIELLY MD PA
FL277263901Medicaid
FL277263902Medicaid
FLME62891OtherME LICENSE