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General NPI Number Information
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NPI Number | 1386890911
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Entity Type | Organization
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Legal Business Name | TLC HOME CARE
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 6598 SHEPHERD OAKS ST
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City | LAKELAND
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State | FL
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Zip | 33811-3160
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Country | US
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Telephone | 863-257-1594
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Fax |
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Provider Business Mailing Address
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Address Line | 6598 SHEPHERD OAKS ST
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City | LAKELAND
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State | FL
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Zip | 33811-3160
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Country | US
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Telephone | 863-257-1594
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. ANGELA MARIE PANNEBAKER
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Credential | RN
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Telephone | 863-257-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | RN3283152
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License Number State | FL
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