Organization
CHILDREN'S EXPRESS CARE CLINIC
Active
Parent organization
CHILDREN'S EXPRESS CARE CLINIC
Other names
Excel Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S EXPRESS CARE CLINIC
Authorized official
SUWARNA M TILAK MD (PRESIDENT)
(904) 519-0008
Entity
Organization
Contact information
Practice address
135 DURBIN STATION CT UNIT 503, ST JOHNS, FL 32259-9370
(904) 519-0008
Mailing address
135 DURBIN STATION CT UNIT 503, ST JOHNS, FL 32259-9370
(904) 519-0008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004548500
—
FL
Enumeration date
06/02/2021
Last updated
06/08/2021
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