Healthcare Provider Details

I. General information

NPI: 1023531704
Provider Name (Legal Business Name): BIG BEND CARES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SOUTH MONROE ST
TALLAHASSEE FL
32301-6303
US

IV. Provider business mailing address

2201 S MONROE ST
TALLAHASSEE FL
32301-6302
US

V. Phone/Fax

Practice location:
  • Phone: 850-354-8765
  • Fax: 850-900-5941
Mailing address:
  • Phone: 850-656-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT RENZI
Title or Position: CEO
Credential:
Phone: 850-656-2437