Provider Demographics
NPI:1215113659
Name:THE FAMILY PRACTICE OF TAMARAC, CORP
Entity type:Organization
Organization Name:THE FAMILY PRACTICE OF TAMARAC, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-486-1925
Mailing Address - Street 1:4699 NORTH STATE ROAD 7
Mailing Address - Street 2:SUITE B2
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-486-1925
Mailing Address - Fax:954-486-1983
Practice Address - Street 1:4699 N STATE ROAD 7
Practice Address - Street 2:SUITE B2
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5879
Practice Address - Country:US
Practice Address - Phone:954-486-1925
Practice Address - Fax:954-486-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM 14257OtherDOH