Provider Demographics
NPI:1093398802
Name:TCL MEDICAL
Entity Type:Organization
Organization Name:TCL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GANIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-490-8670
Mailing Address - Street 1:6613 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5728
Mailing Address - Country:US
Mailing Address - Phone:727-954-4543
Mailing Address - Fax:727-954-4586
Practice Address - Street 1:6613 49TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5728
Practice Address - Country:US
Practice Address - Phone:727-954-4543
Practice Address - Fax:727-954-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty