Provider Demographics
NPI:1124630843
Name:TLC WOMENS HEALTH CENTER, LLC
Entity type:Organization
Organization Name:TLC WOMENS HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIANELLYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNM
Authorized Official - Phone:954-670-9012
Mailing Address - Street 1:1000 N HIATUS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3096
Mailing Address - Country:US
Mailing Address - Phone:954-670-9012
Mailing Address - Fax:
Practice Address - Street 1:1000 N HIATUS RD STE 160
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3096
Practice Address - Country:US
Practice Address - Phone:954-670-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty