MEDICARE: COMMUNITY ROOTS HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	2084P0800X	Psychiatry Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1821958406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ROOTS HEALTH LLC

Provider Business Mailing Address
First Line	:	181 PEPPERPIKE WAY # 32092
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5507
Country	:	US
Telephone Number	:	386-267-7376
Fax Number	:	386-267-7318

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR STE 6
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-3826
Country	:	US
Telephone Number	:	386-267-7318
Fax Number	:	386-267-7318

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATYA MARIA TSANGARAKIS
Credential	:	APRN
Telephone Number	:	954-940-0453

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	06/14/2026

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Directions to “COMMUNITY ROOTS HEALTH LLC ” Practice Location

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