Healthcare Provider Details

I. General information

NPI: 1174888549
Provider Name (Legal Business Name): TALLAHASSEE MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTERVILLE RD SUITE 100
TALLAHASSEE FL
32308-4647
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 850-877-5183
  • Fax: 850-656-1288
Mailing address:
  • Phone: 850-431-7021
  • Fax: 850-431-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateFL

VIII. Authorized Official

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