MEDICARE: F O UR HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1710635412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F O UR HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3191 KERNAN LAKE CIR APT 204
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-3338
Country	:	US
Telephone Number	:	190-437-7376
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 KORI RD STE 9
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-2419
Country	:	US
Telephone Number	:	904-377-3769
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MISS TANYA FELICIA ADAMS
Credential	:	ARNP
Telephone Number	:	904-377-3769

Provider Enumeration Date	:	03/13/2022
Last Update Date	:	04/15/2024

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Directions to “F O UR HEALTHCARE LLC ” Practice Location

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