Provider Demographics
NPI:1124603279
Name:DEVOTED CARE SPECIALIST LLC
Entity Type:Organization
Organization Name:DEVOTED CARE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MULKEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:813-304-3505
Mailing Address - Street 1:PO BOX 310872
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33680-0872
Mailing Address - Country:US
Mailing Address - Phone:352-214-2680
Mailing Address - Fax:
Practice Address - Street 1:4215 E PARIS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-2540
Practice Address - Country:US
Practice Address - Phone:813-304-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health