Provider Demographics
NPI:1114310851
Name:LONGLEAF PEDIATRICS PA
Entity Type:Organization
Organization Name:LONGLEAF PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-532-0800
Mailing Address - Street 1:PO BOX 740715
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-0715
Mailing Address - Country:US
Mailing Address - Phone:386-532-0800
Mailing Address - Fax:386-532-7005
Practice Address - Street 1:103 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7003
Practice Address - Country:US
Practice Address - Phone:386-532-0800
Practice Address - Fax:386-532-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL255837800261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255837800Medicaid