Healthcare Provider Details

I. General information

NPI: 1467012393
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 CENTENNIAL BLVD STE 100
TALLAHASSEE FL
32308-0606
US

IV. Provider business mailing address

1607 SAINT JAMES CT STE 1
TALLAHASSEE FL
32308-5352
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5404
  • Fax:
Mailing address:
  • Phone: 850-431-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PARKS
Title or Position: PRESIDENT
Credential:
Phone: 850-431-6234