Provider Demographics
NPI:1659443687
Name:PEDIATRIC ALLIANCE OF NW FL
Entity Type:Organization
Organization Name:PEDIATRIC ALLIANCE OF NW FL
Other - Org Name:BREEZE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-932-5348
Mailing Address - Street 1:204 CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561
Mailing Address - Country:US
Mailing Address - Phone:850-932-5348
Mailing Address - Fax:850-932-7740
Practice Address - Street 1:204 CENTER ROAD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-932-5348
Practice Address - Fax:850-932-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66613208000000X
FLME87800208000000X
FLARNP2874202363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90004Medicare UPIN