NPIMap

Organization Active NPI

Angel Kids PA

  • Pediatrics Physician
  • St Johns, FL
National Provider Identifier
1386210367
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ANGEL KIDS PA
Practice address
774 State Road 13
St Johns, FL 32259-3857
Phone
(904) 242-4220
NPI assigned
Jun 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Azza Ghandour
Title
Billing/Credentialing Manager
Phone
(904) 242-4220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

774 State Road 13
St Johns, FL 32259-3857

Mailing address

13241 Bartram Park Blvd Unit 209
Jacksonville, FL 32258-5233
Phone (904) 242-4220

Other names 1

  • Angel Kids Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Angel Kids PA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

774 State Road 13 N
St Johns, FL 32259
Phone (904) 224-5437

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1386210367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585233",
            "telephone_number": "904-242-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 STATE ROAD 13",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322593857",
            "telephone_number": "904-242-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL KIDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "GHANDOUR",
        "authorized_official_first_name": "AZZA",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-242-4220"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Kids Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.