Healthcare Provider Details

I. General information

NPI: 1215113659
Provider Name (Legal Business Name): THE FAMILY PRACTICE OF TAMARAC, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 N STATE ROAD 7 SUITE B2
LAUDERDALE LAKES FL
33319-5879
US

IV. Provider business mailing address

4699 NORTH STATE ROAD 7 SUITE B2
TAMARAC FL
33319
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-1925
  • Fax: 954-486-1983
Mailing address:
  • Phone: 954-486-1925
  • Fax: 954-486-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHCC7924
License Number StateFL

VIII. Authorized Official

Name: MS. VICTORIA HATCHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-486-1925