=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952726671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARVARES JERMIANE DOWNING
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 02/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 TEMPLE CIR
-----------------------------------------------------
City | HAINES CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33844-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-353-2543
-----------------------------------------------------
Fax | 863-353-2543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 TEMPLE CIR
-----------------------------------------------------
City | HAINES CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33844-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-353-2543
-----------------------------------------------------
Fax | 863-353-2543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------