MEDICARE: FLORIDA MEMORY CARE AND NEUROLOGY SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1700479094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEMORY CARE AND NEUROLOGY SERVICES LLC

Provider Business Mailing Address
First Line	:	4179 S RIVERBOAT RD STE 220
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-2986
Country	:	US
Telephone Number	:	801-755-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	28420 BONITA CROSSINGS BLVD UNIT 110
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-3203
Country	:	US
Telephone Number	:	239-235-0380
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA TANDY
Credential	:
Telephone Number	:	801-590-9267

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	03/06/2026

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