Healthcare Provider Details

I. General information

NPI: 1780128769
Provider Name (Legal Business Name): TALLAHASSEE SLEEP DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E PLAZA DR STE 103
TALLAHASSEE FL
32308-5327
US

IV. Provider business mailing address

1605 E PLAZA DR STE 103
TALLAHASSEE FL
32308-5327
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-7271
  • Fax: 850-878-1509
Mailing address:
  • Phone: 850-878-7271
  • Fax: 850-878-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number225168
License Number StateFL

VIII. Authorized Official

Name: MRS. JEANNE PATRICIA HUFFMASTER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 850-878-7271