Provider Demographics
NPI:1710651112
Name:PEDIATRICS AT CAYDENS CORNER LLC
Entity Type:Organization
Organization Name:PEDIATRICS AT CAYDENS CORNER LLC
Other - Org Name:PEDIATRICS AT CAYDENS CORNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-790-9590
Mailing Address - Street 1:19800 TIMBERBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2602
Mailing Address - Country:US
Mailing Address - Phone:813-503-5004
Mailing Address - Fax:
Practice Address - Street 1:19800 TIMBERBLUFF DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2602
Practice Address - Country:US
Practice Address - Phone:813-503-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care