MEDICARE: TAMARA BELCHER-BOSTICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	FL
2	343900000X	Non-emergency Medical Transport (VAN)	FL
3	376J00000X	Homemaker
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1306497672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA BELCHER-BOSTICK

Provider Business Mailing Address
First Line	:	2020 ALMIRA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-4604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 ALMIRA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-4604
Country	:	US
Telephone Number	:	904-888-0984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	09/26/2019

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Directions to “ TAMARA BELCHER-BOSTICK ” Practice Location

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