Healthcare Provider Details

I. General information

NPI: 1154483642
Provider Name (Legal Business Name): TIDEWELL HOSPICE & PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2967 BEE RIDGE RD SUITE 3
SARASOTA FL
34239-7113
US

IV. Provider business mailing address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

V. Phone/Fax

Practice location:
  • Phone: 941-929-2369
  • Fax: 941-929-2363
Mailing address:
  • Phone: 941-552-7683
  • Fax: 941-552-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299991723
License Number StateFL

VIII. Authorized Official

Name: JONATHAN DAVID FLEECE
Title or Position: CEO
Credential:
Phone: 941-552-7525