Healthcare Provider Details

I. General information

NPI: 1578031027
Provider Name (Legal Business Name): TLC, HEALTH & EDUCATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 W WANDER RD
NEW RIVER AZ
85087-6903
US

IV. Provider business mailing address

2940 W WANDER RD
NEW RIVER AZ
85087-6903
US

V. Phone/Fax

Practice location:
  • Phone: 623-221-4409
  • Fax: 623-465-3276
Mailing address:
  • Phone: 623-221-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARLA ELAINE SAMPLE-ORMES
Title or Position: CEO
Credential: MSN,NP-BC
Phone: 623-221-4409