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General NPI Number Information
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NPI Number | 1821679911
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Entity Type | Organization
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Legal Business Name | JATA CARE
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1375 GATEWAY BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-577-2734
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 GATEWAY BLVD STE 16
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-562-1816
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARA LYNETTE SUKIE
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Credential | ARNP
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Telephone | 561-562-1816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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