Healthcare Provider Details

I. General information

NPI: 1114310927
Provider Name (Legal Business Name): TYLER & JACOB CONSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18501 PINES BLVD SUITE 300
PEMBROKE PINES FL
33029-1414
US

IV. Provider business mailing address

18501 PINES BLVD SUITE 300
PEMBROKE PINES FL
33029-1414
US

V. Phone/Fax

Practice location:
  • Phone: 866-462-7202
  • Fax: 866-656-2662
Mailing address:
  • Phone: 866-462-7202
  • Fax: 866-656-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA WILLIAMS
Title or Position: VICE PRESIDENT
Credential: RN
Phone: 866-462-7202