Provider Demographics
NPI:1093409765
Name:WAVES-OF-LIFE FAMILY TELEHEALTH SERVICES
Entity Type:Organization
Organization Name:WAVES-OF-LIFE FAMILY TELEHEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALBINO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-FNP
Authorized Official - Phone:689-213-5334
Mailing Address - Street 1:1870 STILLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8022
Mailing Address - Country:US
Mailing Address - Phone:407-973-5266
Mailing Address - Fax:
Practice Address - Street 1:1870 STILLWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8022
Practice Address - Country:US
Practice Address - Phone:407-973-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty