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: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 STATE ROAD 16 STE 114
ST AUGUSTINE FL
32092-5401
US

IV. Provider business mailing address

2730 STATE ROAD 16 STE 114
ST AUGUSTINE FL
32092-5401
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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