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General NPI Number Information
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NPI Number | 1215113659
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Entity Type | Organization
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Legal Business Name | THE FAMILY PRACTICE OF TAMARAC, CORP
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 4699 N STATE ROAD 7 SUITE B2
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5879
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Country | US
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Telephone | 954-486-1925
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Fax | 954-486-1983
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Provider Business Mailing Address
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Address Line | 4699 NORTH STATE ROAD 7 SUITE B2
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City | TAMARAC
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State | FL
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Zip | 33319
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Country | US
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Telephone | 954-486-1925
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Fax | 954-486-1983
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. VICTORIA HATCHER
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Credential |
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Telephone | 954-486-1925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | HCC7924
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License Number State | FL
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