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General NPI Number Information
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NPI Number | 1902178775
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Entity Type | Organization
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Legal Business Name | TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 910 S WINTERHAWK DR SUITE 101
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3870
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Country | US
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Telephone | 904-217-7648
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Fax | 352-666-3232
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Provider Business Mailing Address
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Address Line | 910 S WINTERHAWK DR SUITE 101
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3870
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Country | US
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Telephone | 904-217-7648
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Fax | 352-666-3232
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PHYLLIS MIDDLETON
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Credential |
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Telephone | 904-217-7648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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