Provider Demographics
NPI:1831810530
Name:TOTAL BODY AESTHETICS AND MEDICAL CARE
Entity type:Organization
Organization Name:TOTAL BODY AESTHETICS AND MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAICHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:407-484-0266
Mailing Address - Street 1:595 W CHURCH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-2209
Mailing Address - Country:US
Mailing Address - Phone:407-484-0266
Mailing Address - Fax:
Practice Address - Street 1:595 W CHURCH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2209
Practice Address - Country:US
Practice Address - Phone:407-440-3560
Practice Address - Fax:407-674-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty