Healthcare Provider Details

I. General information

NPI: 1780906065
Provider Name (Legal Business Name): TENDER CARE MEDICAL SERVICES OF ST JOHNS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2010
Last Update Date: 02/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SAINT JOHNS MEDICAL PK DR
ST AUGUSTINE FL
32086-5298
US

IV. Provider business mailing address

PO BOX 5159
SPRING HILL FL
34611-5159
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-6831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PHILIP MAZZUCO
Title or Position: OWNER
Credential:
Phone: 352-683-6831