Healthcare Provider Details

I. General information

NPI: 1659280477
Provider Name (Legal Business Name): TS MIRACLE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N FISKE BLVD APT 2C
COCOA FL
32922-5818
US

IV. Provider business mailing address

1080 N FISKE BLVD APT 2C
COCOA FL
32922-5818
US

V. Phone/Fax

Practice location:
  • Phone: 321-271-2912
  • Fax:
Mailing address:
  • Phone: 321-271-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TACHIARA JOHNSON
Title or Position: OWNER
Credential:
Phone: 321-271-2912