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General NPI Number Information
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NPI Number | 1447763446
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Entity Type | Organization
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Legal Business Name | JOHN TICE INC.
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 67 STEPHENSON DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4918
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Country | US
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Telephone | 321-723-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 67 STEPHENSON DR
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN JOHN
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Credential |
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Telephone | 321-723-0720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number | T200466522150
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License Number State | FL
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