MEDICARE: TREASURE COAST MEDICAL AND HOLISTIC CARE, 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	261QP2300X	Primary Care Clinic/Center	363L00000X	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831477553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST MEDICAL AND HOLISTIC CARE, LLC

Provider Business Mailing Address
First Line	:	1255 SW CURRY STREET
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-2509
Country	:	US
Telephone Number	:	772-418-4036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 SW CURRY STREET
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-2509
Country	:	US
Telephone Number	:	772-418-4036
Fax Number	:

Authorized Official
Title or Position	:	ARNP/OWNER
Name	:	MS. LUZ SCHELMETY-HENRIQUEZ
Credential	:	ARNP
Telephone Number	:	772-418-4036

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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