Healthcare Provider Details

I. General information

NPI: 1104658103
Provider Name (Legal Business Name): DEMAC HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 W STATE ROAD 434 STE 111
LONGWOOD FL
32779-4884
US

IV. Provider business mailing address

1970 E OSCEOLA PKWY STE 338
KISSIMMEE FL
34743-8629
US

V. Phone/Fax

Practice location:
  • Phone: 407-741-3690
  • Fax:
Mailing address:
  • Phone: 407-741-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICA TILUS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 407-844-9440