JULINGTON CREEK PEDIATRICS (NPI# 1902124522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902124522 |
| Entity Type | Organization |
| Organization Name | JULINGTON CREEK PEDIATRICS |
| Practice Address |
774 State Road 13 Suite 6 Saint Johns FL 32259-3857 |
| Practice Telephone | 9042305437 |
| Practice Fax Number | 9042307337 |
| Mailing Telephone | 9042305437 |
| Mailing Fax Number | 9042307337 |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |
| Authorized Official Name | MRS. VICTORIA MOSTELLER (PEDIATRIC PHYSICIAN) |
| Authorized Official Telephone | 9042305437 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | ME74170 | FL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | TRICARE | 1679682264 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891188173 | Julington Creek Pediatrics | Preferred Provider Organization | 774 State Road 13 Ste 6, Jacksonville, FL 32259-3815 | 2015-03-11 |
| Street Address |
774 STATE ROAD 13 SUITE 6 |
| City | SAINT JOHNS |
| State | FL |
| Zip Code | 32259-3857 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194099077 | Peggy Bailey Lmhc Inc | Counselor | 774 State Road 13, Ste 7, Saint Johns, FL 32259-3857 | 2012-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659904571 | Ayla Rose Yarbrough | Chiropractor | 1620 County Road 210, St. Johns County, FL 32259 | 2020-02-19 |
| 1831731009 | Andrew Dacunha, Dmd, Pa | Dentist | 71 Doctors Village Drive, Suite 303, Saint Johns, FL 32259 | 2019-10-09 |
| 1801446257 | Mary Alice Taylor | Counselor | 213 Trapper Trace Ct., St. Johns, FL 32259 | 2019-09-18 |
| 1609425826 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 155 Bartram Park Drive, Suite 100, St. Johns, FL 32259 | 2019-09-10 |
| 1518438936 | Yazji Pediatric Care | Pediatrics | 4125 Race Track Rd, Suite Number 104, Saint Johns, FL 32259 | 2018-12-11 |
| 1003328022 | Abundant Life Health Center LLC | Chiropractor | 254 Everest Lane, St. Johns, FL 32259 | 2017-10-31 |
| 1356863732 | Jennifer Eberhard | Nurse Practitioner | 335 Oxford Estates Way, Saint Johns, FL 32259 | 2017-07-07 |
| 1366986861 | Taylor Leard | Physician Assistant | 2001 County Rd 210, Suite 101, St. Johns, FL 32259 | 2016-12-19 |
| 1043760390 | Comfortable Care Dental Health Professionals, Pa | Dentist | 2532 Race Track Rd, Saint Johns, FL 32259 | 2016-10-11 |
| 1598114233 | Bright Smiles Pediatric Dentistry, Pllc | Dentist | 196 Everest Ln Unit 1, Saint Johns, FL 32259 | 2016-06-03 |
| Find all providers in zip 32259 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255799896 | Mental South Wellness Pa | Specialist | 125 Edgewater Branch Dr, Saint Johns, FL 32259-4417 | 2016-02-09 |
| 1336465780 | Dennis Stone, M.d., P.a. | Specialist | 3408 State Road 13, Saint Johns, FL 32259-9270 | 2010-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437758893 | Ursula Olazabal | Specialist | 402 N Babcock St Ste 101, Melbourne, FL 32935-7335 | 2020-10-18 |
| 1043818529 | Michele Rosenthal | Specialist | 425 Greenwich Circle, #107, Jupiter, FL 33458-4809 | 2020-10-15 |
| 1184230096 | Lauren Daisey Woodruff | Specialist | 4440 Nelson Ave, Sarasota, FL 34231-7515 | 2020-09-17 |
| 1699385823 | Suzanne Denise Moe | Specialist | 48 Nw 4th St, Homestead, FL 33030-5942 | 2020-08-03 |
| 1437768033 | Coastal Injury Clinic LLC | Specialist | 2700 Riverside Ave Ste 1, Jacksonville, FL 32205-8233 | 2020-07-29 |
| 1417566712 | Angela Berry Williams | Specialist | 5175 W Atlantic Ave Ste C, Delray Beach, FL 33484-8101 | 2020-07-23 |
| 1255957643 | Rhonda D Smith Roberts | Specialist | 2754 Sam Hardwick Blvd, Jacksonville, FL 32246-3892 | 2020-06-22 |
| 1316562911 | A School 4 Legends LLC | Specialist | 11565 Se 57th Ct, Belleview, FL 34420-4361 | 2020-06-10 |
| 1700400397 | Juda Mclaren | Specialist | 7360 Beacon Hill Loop Apt 8, Orlando, FL 32818-6431 | 2020-05-30 |
| 1811518384 | Lori Rubin | Specialist | 8181 W Broward Blvd Ste 204, Plantation, FL 33324-2049 | 2020-05-06 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOHNS |
| Zip Code | 32259 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.