Healthcare Provider Details

I. General information

NPI: 1063658086
Provider Name (Legal Business Name): TREASURE COAST PALLIATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE INDIAN ST
STUART FL
34997-5688
US

IV. Provider business mailing address

1201 SE INDIAN ST
STUART FL
34997-5688
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-4500
  • Fax: 772-781-8031
Mailing address:
  • Phone: 772-403-4500
  • Fax: 772-781-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE KENDRICK
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 772-403-4500