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General NPI Number Information
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NPI Number | 1962515437
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Entity Type | Organization
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Legal Business Name | TIOMICO-TRAHAN FAMILY CARE CENTER PA
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 7740 POINT MEADOWS DR SUITE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9179
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Country | US
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Telephone | 904-641-6110
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Fax | 904-641-0866
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Provider Business Mailing Address
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Address Line | PO BOX 890594
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City | CHARLOTTE
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State | NC
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Zip | 28289-0594
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Country | US
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Telephone | 904-282-6331
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Fax | 904-282-1550
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA GINA TIOMICO-TRAHAN
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Credential | M.D.
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Telephone | 904-641-6110
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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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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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