Provider Demographics
NPI:1346804077
Name:TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Entity type:Organization
Organization Name:TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZUCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-683-6831
Mailing Address - Street 1:PO BOX 5159
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5159
Mailing Address - Country:US
Mailing Address - Phone:352-683-6831
Mailing Address - Fax:
Practice Address - Street 1:927 S STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9397
Practice Address - Country:US
Practice Address - Phone:386-336-9028
Practice Address - Fax:386-336-9029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care