Healthcare Provider Details

I. General information

NPI: 1811093644
Provider Name (Legal Business Name): INFORMED CARE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE SUITE 104
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

PO BOX 6250
CHARLOTTESVILLE VA
22906-6250
US

V. Phone/Fax

Practice location:
  • Phone: 407-865-7134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME48279
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 2555892
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1449212
License Number StateFL

VIII. Authorized Official

Name: CYNTHIA THOMAS
Title or Position: VP CLINICAL SERVICES
Credential:
Phone: 434-977-9719