Provider Demographics
NPI:1700027760
Name:PICC CENTRAL LLC
Entity Type:Organization
Organization Name:PICC CENTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEPP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-231-9576
Mailing Address - Street 1:119 E WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5853
Mailing Address - Country:US
Mailing Address - Phone:321-231-9576
Mailing Address - Fax:407-302-0449
Practice Address - Street 1:119 E WOODLAND DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5853
Practice Address - Country:US
Practice Address - Phone:321-231-9576
Practice Address - Fax:407-302-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9222948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty