JEFFREY TEGENKAMP


Address: 5622 Woodbine Rd, Pace, FL 32571-8767
Phone: 8509104840

JEFFREY TEGENKAMP (NPI# 1366999104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1366999104
Entity Type Individual
Full Name JEFFREY TEGENKAMP
Practice Address 5622 Woodbine Rd
Pace
FL 32571-8767
Practice Telephone 8509104840
Enumeration Date 2016-09-09
Last Update Date 2016-09-09
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 156FX1800X Technician/Technologist
Specialization: Optician
DO3542 FL Eye and Vision Services Providers

Office Location

Street Address 5622 WOODBINE RD
City PACE
State FL
Zip Code 32571-8767

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1326468323 Ileana Bernal-blair Obstetrics & Gynecology 3574 Highway 90, Ste 220, Pace, FL 32571 2014-04-17
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Taxonomy Information

Taxonomy Code 156FX1800X
Grouping Eye and Vision Services Providers
Classification Technician/Technologist
Specialization Optician

Taxonomy Definition

Definition to come...

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Competitor

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City PACE
Zip Code 32571

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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