Healthcare Provider Details

I. General information

NPI: 1821958406
Provider Name (Legal Business Name): COMMUNITY ROOTS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ZEAGLER DR STE 6
PALATKA FL
32177-3826
US

IV. Provider business mailing address

700 ZEAGLER DR STE 6
PALATKA FL
32177-3826
US

V. Phone/Fax

Practice location:
  • Phone: 386-267-7318
  • Fax: 386-267-7318
Mailing address:
  • Phone: 386-267-7376
  • Fax: 386-267-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATYA MARIA TSANGARAKIS
Title or Position: OWNER
Credential: APRN
Phone: 954-940-0453