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General NPI Number Information
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NPI Number | 1821958406
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Entity Type | Organization
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Legal Business Name | COMMUNITY ROOTS HEALTH LLC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 700 ZEAGLER DR STE 8
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City | PALATKA
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State | FL
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Zip | 32177-3826
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Country | US
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Telephone | 904-325-6423
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Fax |
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Provider Business Mailing Address
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Address Line | 181 PEPPERPIKE WAY # 32092
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-5507
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Country | US
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Telephone | 904-325-6423
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Fax | 904-734-3895
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATYA MARIA TSANGARAKIS
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Credential | APRN
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Telephone | 954-940-0453
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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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