Provider Demographics
NPI:1144429432
Name:KEE, TRISHA VANBREDERODE
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:VANBREDERODE
Last Name:KEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12276 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8628
Mailing Address - Country:US
Mailing Address - Phone:904-288-8910
Mailing Address - Fax:904-288-8912
Practice Address - Street 1:12276 SAN JOSE BLVD
Practice Address - Street 2:SUITE 507
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8628
Practice Address - Country:US
Practice Address - Phone:904-288-8910
Practice Address - Fax:904-288-8912
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNONE2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812042100Medicaid