Healthcare Provider Details

I. General information

NPI: 1558038182
Provider Name (Legal Business Name): TREASURE COAST COMMUNITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 27TH ST
VERO BEACH FL
32960-0303
US

IV. Provider business mailing address

1555 INDIAN RIVER BLVD STE B210
VERO BEACH FL
32960-7113
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-8224
  • Fax: 772-213-3157
Mailing address:
  • Phone: 772-257-8224
  • Fax: 772-213-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI SOULE
Title or Position: CEO
Credential:
Phone: 772-257-8224