Provider Demographics
NPI:1851640395
Name:TZIMENATOS, CAROL D
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:D
Last Name:TZIMENATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 IXORIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6250
Mailing Address - Country:US
Mailing Address - Phone:772-468-3910
Mailing Address - Fax:773-468-3979
Practice Address - Street 1:404 IXORIA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6250
Practice Address - Country:US
Practice Address - Phone:772-468-3910
Practice Address - Fax:773-468-3979
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator