=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285436758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMERA RESHONDA KING BSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 SW ALLIANCE TRAIL #4
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-724-6040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6625 ARGYLE FOREST BLVD STE 4 1016
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32244-6670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-724-6040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | L25000114697
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number | L25000114697
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------