Provider Demographics
NPI:1013443423
Name:FLIP FLOPS AND LOLLIPOPS PEDIATRICS
Entity type:Organization
Organization Name:FLIP FLOPS AND LOLLIPOPS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LERA
Authorized Official - Middle Name:LIV
Authorized Official - Last Name:FINA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-572-1884
Mailing Address - Street 1:22455 FLORA PARKE XING
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8000
Mailing Address - Country:US
Mailing Address - Phone:904-572-1884
Mailing Address - Fax:904-491-1118
Practice Address - Street 1:22455 FLORA PARKE XING
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8000
Practice Address - Country:US
Practice Address - Phone:904-572-1884
Practice Address - Fax:904-491-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66488261QP2300X
FLOS 10686261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care