Active NPI
Tawanda Jeannette Jeffcoat
- Health Maintenance Organization
- Wilmington, DE
National Provider Identifier
1104209469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 46-3211044
- Practice address
- 225 Filbert Ave
Wilmington, DE 19805-2549 - Phone
- (302) 543-3219
- NPI assigned
- Jul 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 46-3211044 | DE | Primary |
Addresses
Primary practice location
225 Filbert Ave
Wilmington, DE 19805-2549
Mailing address
225 Filbert Ave
Wilmington, DE 19805-2549
Phone (302) 543-3219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46-3211044 | DE | MD | Health Maintenance Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436140800000",
"number": "1104209469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 FILBERT AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198052549",
"telephone_number": "302-543-3219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 FILBERT AVE",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198052549",
"telephone_number": "302-543-3219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFCOAT",
"first_name": "TAWANDA",
"middle_name": "JEANNETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-06",
"last_updated": "2015-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "DE",
"license": "46-3211044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.