Provider Demographics
NPI:1023069036
Name:PEDIATRIX MEDICAL GROUP
Entity type:Organization
Organization Name:PEDIATRIX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOUY
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:850-939-7911
Mailing Address - Street 1:7552 N SHORES DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8435
Mailing Address - Country:US
Mailing Address - Phone:850-939-7911
Mailing Address - Fax:850-939-9719
Practice Address - Street 1:5149 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8756
Practice Address - Country:US
Practice Address - Phone:850-416-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312852282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren