Healthcare Provider Details

I. General information

NPI: 1336803501
Provider Name (Legal Business Name): FLETCHER'S TENDER CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 BEACHWAY RD
JACKSONVILLE FL
32207-2320
US

IV. Provider business mailing address

59 19TH AVENUE NORTH
JACKSONVILLE FL
32250
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-9797
  • Fax: 904-399-8474
Mailing address:
  • Phone: 904-759-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DAVID FLETCHER
Title or Position: PRESIDENT
Credential:
Phone: 904-759-3203