Healthcare Provider Details

I. General information

NPI: 1184505489
Provider Name (Legal Business Name): ECCENTIA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 S NOVA RD STE P1010
PORT ORANGE FL
32129-4292
US

IV. Provider business mailing address

3761 S NOVA RD STE P1010
PORT ORANGE FL
32129-4292
US

V. Phone/Fax

Practice location:
  • Phone: 386-451-4980
  • Fax:
Mailing address:
  • Phone: 386-766-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TAMARA EDWARDS
Title or Position: OWNER
Credential:
Phone: 386-451-4980