St. John'S Pediatrics, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME90096 Issued in FL

Legal business name

ST. JOHN'S PEDIATRICS, PA

Practice address

161 Hampton Point Drive Ste 4
Saint Augustine, FL 32092-3057

Phone

(904) 230-0624

Fax

(904) 230-7947

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Leticia Rosario Abrea, M.D.NPI 1710911706

Title

President

Phone

(904) 807-9112

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

St John'S Pediatrics PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• St. John'S Pediatrics, P.a.

  • Pediatrics Physician
  • Saint Augustine, FL
  • NPI 1386843506
  NPD tax ID

Locations

Practitioners 1

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

• Leticia Rosario Abrea, M.D.

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1710911706
  NPD (past) Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1467590711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 HAMPTON POINT DRIVE STE 4",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320923057",
            "telephone_number": "904-230-0624",
            "fax_number": "904-230-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 HAMPTON POINT DRIVE STE 4",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320923057",
            "telephone_number": "904-230-0624",
            "fax_number": "904-230-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "ABREA",
        "authorized_official_first_name": "LETICIA",
        "authorized_official_middle_name": "ROSARIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-807-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME90096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "28637",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Augustine Pediatric Associates, PA
• St. Augustine Pediatric Associates, PA
• St. Augustine Surgery Center
• St. Augustine Therapy LLC
• St. John'S Pediatrics, P.a.
• St. Johns County Council on Aging Inc.
• St. Johns County School District
• St. Johns County School District
• St. Johns County School District
• St. Johns County School District

• Pediatrics Physician in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.