Healthcare Provider Details

I. General information

NPI: 1114752920
Provider Name (Legal Business Name): TANDA CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 US 1 S STE 207
ST AUGUSTINE FL
32086-3203
US

IV. Provider business mailing address

1075 FRONT ST
WELAKA FL
32193-2072
US

V. Phone/Fax

Practice location:
  • Phone: 904-680-5908
  • Fax:
Mailing address:
  • Phone: 904-315-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY ROSE PHILLIPS
Title or Position: OWNER
Credential:
Phone: 904-315-2989