Healthcare Provider Details

I. General information

NPI: 1720401698
Provider Name (Legal Business Name): NINI'S TLC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5118 EL DORADO DR
TAMPA FL
33615-4712
US

IV. Provider business mailing address

5118 EL DORADO DR
TAMPA FL
33615-4712
US

V. Phone/Fax

Practice location:
  • Phone: 813-885-2170
  • Fax: 813-885-2183
Mailing address:
  • Phone: 813-885-2170
  • Fax: 813-885-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL-11676
License Number StateFL

VIII. Authorized Official

Name: MISS LURIAN OSORIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-885-2170