Provider Demographics
NPI:1790973402
Name:TREE HOUSE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:TREE HOUSE PEDIATRICS PLLC
Other - Org Name:TREE HOUSE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-736-8733
Mailing Address - Street 1:10743 NARCOOSSEE RD
Mailing Address - Street 2:SUITE A 13
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832
Mailing Address - Country:US
Mailing Address - Phone:407-736-8733
Mailing Address - Fax:407-736-8669
Practice Address - Street 1:10743 NARCOOSSEE RD
Practice Address - Street 2:SUITE A13
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:407-736-8733
Practice Address - Fax:407-736-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty