ABRAKIDABRA PEDIATRIC CLINIC, LLC
Medical Practice at Mariner Blvd, Brooksville, FL

License number
Florida 9175935
Category
Medical Practice
Type
Pediatrics
Owner
Name: MRS. HEATHER RIDDLE A.R.N.P.
Title: PRESIDENT
Phone: (352) 678-3100
Address
Address
1198 Mariner Blvd, Brooksville, FL 34609
National Provider ID: 1366699944
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ABRAKIDABRA PEDIATRIC CLINIC LLC

Brooksville, FL

Status:
Inactive
Industry:
Health/Allied Services
Inactive reason:
Lc Amendment
Registration:
May 4, 2011
Inactive since:
Jun 20, 2014
Addresses:
1198 Mariner Blvd, Spring Hill, FL 34609 (Physical)
3510 Mariner Blvd, Brooksville, FL 34609
State ID:
L11000054428
Business type:
Florida Limited Liability Company
Managing Members:
Heather Aarnp Riddle (Managing Member), 1198 Mariner Blvd, Spring Hill, FL 34609 (Physical),Michael Riddle Manager, inactive,Mary Reynolds Managing Member, inactive
Agent:
Riddle, Heather,1198 Mariner Blvd, Spring Hill, FL 34609 (Physical)
EIN:
900722173

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