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General NPI Number Information
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NPI Number | 1790465540
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Entity Type | Organization
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Legal Business Name | T AND C WELLNESS CENTER
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 2155 N STATE ROAD 7 STE B
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City | MARGATE
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State | FL
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Zip | 33063-5713
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Country | US
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Telephone | 754-368-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 N STATE ROAD 7 STE B
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City | MARGATE
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State | FL
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Zip | 33063-5713
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Country | US
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Telephone | 754-368-2586
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CAREECIA WALLACE
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Credential | APRN, FNP-BC
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Telephone | 754-368-2586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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