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General NPI Number Information
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NPI Number | 1376161455
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH CARE CLINIC LLC
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 4161 NW 5TH ST STE 201
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City | PLANTATION
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State | FL
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Zip | 33317-2101
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Country | US
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Telephone | 954-300-2404
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Fax | 954-300-2404
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Provider Business Mailing Address
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Address Line | 4161 NW 5TH ST STE 201
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City | PLANTATION
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State | FL
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Zip | 33317-2101
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Country | US
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Telephone | 954-907-6719
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | GERALDINE HAWKINS
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Credential |
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Telephone | 954-907-6719
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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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