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General NPI Number Information
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NPI Number | 1780273474
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Entity Type | Organization
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Legal Business Name | HEALTHCARE EXTRAORDINARE, LLC
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Dates
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Enumeration Date | 01/16/2021
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Last Update Date | 01/16/2021
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Provider Practice Location Address
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Address Line | 3154 HIGHLAND GROVE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-6855
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Country | US
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Telephone | 904-613-6974
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Fax | 904-375-2012
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Provider Business Mailing Address
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Address Line | 3154 HIGHLAND GROVE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-6855
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Country | US
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Telephone | 904-613-6974
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Fax | 904-375-2012
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Authorized Official
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Title or Position | DNP/APRN
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Name | DR. TANA ROBINSON
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Credential | APRN
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Telephone | 904-613-3974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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