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AQUA BLUE PEDIATRICS PLLC
NPI 1619829900
Pediatrics in Ormond Beach, FL

Active since February 10, 2026CLIA 10D2344398 · Waiver
785 W GRANADA BLVD STE 4, ORMOND BEACH, FL 32174(630) 464-4928 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Aqua Blue Pediatrics Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AQUA BLUE PEDIATRICS PLLC (NPI 1619829900) is a healthcare organization registered as a pediatrics in Ormond Beach, Florida and active in the NPI registry since February 2026. The organization holds a CLIA Waiver certificate valid through May 20, 2028 and lists Brandon Betancourt, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1619829900
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameAQUA BLUE PEDIATRICS PLLC
Location Address785 W GRANADA BLVD STE 4Ormond Beach, FL 32174-5163
Mailing Address7901 4th St N # 30729St Petersburg, FL 33702-4305 · (630) 464-4928 · Fax (847) 854-9403
Phone(630) 464-4928
Organization SubpartNo
Authorized OfficialBrandon BetancourtPractice Administrator · (847) 854-9402
Enumeration DateFebruary 10, 2026
NPPES CertifiedFebruary 10, 2026
✔ NPI 1619829900 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
785 W GRANADA BLVD STE 4, Ormond Beach, FL 32174
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2344398

Aqua Blue Pediatrics PLLC · Ormond Beach, FL
Active · expires May 20, 2028
CLIA Number10D2344398
Laboratory TypePhysician Office
Certificate Effective DateMay 21, 2026
Certificate Expiration DateMay 20, 2028
Laboratory DirectorJoanna E. Betancourt
Laboratory Phone(630) 464-4928
Laboratory LocationAqua Blue Pediatrics PLLC785 W Granada Blvd Suite 4, Ormond Beach, FL 32174
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PREMIER ALLERGIST OF FLORIDA LLC
Allergy & Immunology
785 W GRANADA BLVD STE 4
ORMOND BEACH, FL 32174
Flagler County (386) 673-1323

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Aqua Blue Pediatrics PLLC's NPI number?

The NPI number for Aqua Blue Pediatrics PLLC is 1619829900. It was assigned to this organization in the NPPES registry on February 10, 2026.

Where is Aqua Blue Pediatrics PLLC located?

Aqua Blue Pediatrics PLLC is located at 785 W Granada Blvd Ste 4, Ormond Beach, FL 32174. The listed phone number is (630) 464-4928.

What is Aqua Blue Pediatrics PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Aqua Blue Pediatrics PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2344398) is associated with this NPI, valid through May 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Aqua Blue Pediatrics PLLC was last updated on February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.