Healthcare Provider Details

I. General information

NPI: 1902178775
Provider Name (Legal Business Name): TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S WINTERHAWK DR SUITE 101
ST AUGUSTINE FL
32086-3870
US

IV. Provider business mailing address

910 S WINTERHAWK DR SUITE 101
ST AUGUSTINE FL
32086-3870
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-7648
  • Fax: 352-666-3232
Mailing address:
  • Phone: 904-217-7648
  • Fax: 352-666-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLIS MIDDLETON
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-217-7648