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General NPI Number Information
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NPI Number | 1356905079
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Entity Type | Organization
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Legal Business Name | TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 927 S STATE ROAD 19
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City | PALATKA
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State | FL
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Zip | 32177-9397
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Country | US
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Telephone | 386-336-9028
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Fax | 386-336-9029
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Provider Business Mailing Address
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Address Line | PO BOX 5159
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City | SPRING HILL
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State | FL
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Zip | 34611-5159
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Country | US
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Telephone | 352-683-6831
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Fax | 352-666-3200
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MS. LORI MAZZUCO
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Credential |
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Telephone | 352-683-6831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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