Provider Demographics
NPI:1366431280
Name:HERE WE GROW PEDIATRICS, P.A.
Entity type:Organization
Organization Name:HERE WE GROW PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-384-1217
Mailing Address - Street 1:P.O. BOX 530072
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5300
Mailing Address - Country:US
Mailing Address - Phone:727-384-1217
Mailing Address - Fax:727-384-3240
Practice Address - Street 1:6675 38TH AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1594
Practice Address - Country:US
Practice Address - Phone:727-384-1217
Practice Address - Fax:727-384-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263948301Medicaid
FL068656500Medicaid
FL263948300Medicaid
FL263948301Medicaid