Healthcare Provider Details

I. General information

NPI: 1528976628
Provider Name (Legal Business Name): TOMICA PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 E BROAD ST STE 329
FUQUAY VARINA NC
27526-1968
US

IV. Provider business mailing address

1441 E BROAD ST STE 329
FUQUAY VARINA NC
27526-1968
US

V. Phone/Fax

Practice location:
  • Phone: 904-907-0694
  • Fax: 888-892-2593
Mailing address:
  • Phone: 904-907-0694
  • Fax: 888-892-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: