Healthcare Provider Details

I. General information

NPI: 1972807907
Provider Name (Legal Business Name): NINI'S TLC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
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 Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11676
License Number StateFL

VIII. Authorized Official

Name: MISS ENID FLEITAS
Title or Position: PRESIDENT
Credential:
Phone: 813-885-2170