Healthcare Provider Details

I. General information

NPI: 1134494842
Provider Name (Legal Business Name): ACTI-KARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17425 BRIDGE HILL CT STE 200
TAMPA FL
33647-3657
US

IV. Provider business mailing address

17425 BRIDGE HILL CT STE 200
TAMPA FL
33647-3657
US

V. Phone/Fax

Practice location:
  • Phone: 813-767-8456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number15850
License Number StateFL

VIII. Authorized Official

Name: MR. D BRADLEY ROMP
Title or Position: OWNER FRANCHISE DIRECTOR
Credential:
Phone: 813-767-8456