Healthcare Provider Details

I. General information

NPI: 1033455662
Provider Name (Legal Business Name): TYNA L BAUGESS CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2013
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N ALAFAYA TRL
ORLANDO FL
32826-2940
US

IV. Provider business mailing address

1766 SOPHIAS DR APT 202
MELBOURNE FL
32940-6211
US

V. Phone/Fax

Practice location:
  • Phone: 407-215-0095
  • Fax: 407-261-0523
Mailing address:
  • Phone: 614-271-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5629
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number081148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: