Healthcare Provider Details

I. General information

NPI: 1972376234
Provider Name (Legal Business Name): TLC HEALTHCARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/26/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VULCAN RD STE 221
BIRMINGHAM AL
35209-4701
US

IV. Provider business mailing address

105 VULCAN ROAD STE 221 PMB 1100
BIRMINGHAM AL
35209
US

V. Phone/Fax

Practice location:
  • Phone: 205-378-8151
  • Fax: 205-546-8519
Mailing address:
  • Phone: 205-729-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANEE MOORE
Title or Position: FNP-BC
Credential: MSN
Phone: 205-378-8151