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General NPI Number Information
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NPI Number | 1831810530
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Entity Type | Organization
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Legal Business Name | TOTAL BODY AESTHETICS AND MEDICAL CARE
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 595 W CHURCH STREET SUITE F
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City | ORLANDO
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State | FL
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Zip | 32805-2209
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Country | US
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Telephone | 407-440-3560
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Fax | 407-674-6256
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Provider Business Mailing Address
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Address Line | 595 W CHURCH STREET SUITE F
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City | ORLANDO
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State | FL
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Zip | 32805-2209
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Country | US
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Telephone | 407-484-0266
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TAICHE GRIFFIN
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Credential | ARNP
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Telephone | 407-484-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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