Healthcare Provider Details

I. General information

NPI: 1962137984
Provider Name (Legal Business Name): TAMIKA MCCLENDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 PINES BLVD STE 3054
PEMBROKE PINES FL
33027-1212
US

IV. Provider business mailing address

8409 BOTTOM WOODS CIR APT 301
TAMPA FL
33637-5078
US

V. Phone/Fax

Practice location:
  • Phone: 786-326-5899
  • Fax:
Mailing address:
  • Phone: 786-326-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number238511
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number238511
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number238511
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number238511
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number238511
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number238511
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number238511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: