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General NPI Number Information
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NPI Number | 1508107244
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Entity Type | Organization
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Legal Business Name | FAMILY CARE 1 LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 1411 SE 16TH PL
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City | CAPE CORAL
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State | FL
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Zip | 33990
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Country | US
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Telephone | 236-673-6516
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Fax |
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Provider Business Mailing Address
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Address Line | 330 SW 19TH LN
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City | CAPE CORAL
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State | FL
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Zip | 33991-3714
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Country | US
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Telephone | 239-691-0012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELINA TOMSKI
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Credential | MD
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Telephone | 239-691-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME108892
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License Number State | FL
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