Tidajay Care Services Inc

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5159858 Issued in FL

Legal business name

TIDAJAY CARE SERVICES INC

Practice address

1140 Sunray CT
Jacksonville, FL 32218-8038

Phone

(904) 714-1020

Fax

(904) 714-4501

NPI assigned

Feb 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Musu Kaisamba Jusu

Title

Owner

Phone

(904) 714-1020

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1659540763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 SUNRAY CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322188038",
            "telephone_number": "904-714-1020",
            "fax_number": "904-714-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 SUNRAY CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322188038",
            "telephone_number": "904-714-1020",
            "fax_number": "904-714-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAJAY CARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "JUSU",
        "authorized_official_first_name": "MUSU",
        "authorized_official_middle_name": "KAISAMBA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-714-1020",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5159858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Jenny Tibavisky, M.D.
• Kylee Lynn Tibbetts, PTA
• Morgan Tibbo, DO
• Kendra J Tice, RN, MSN,DNP
• Mary Tice, PA
• John Michael Tierney, PA
• Sara Beth Tierney, LCSW
• Vicki D Tierney, OTR, MHS
• Tiffany Baltiero LMT LLC
• Tiffany's Homemaker and Companion

• Licensed Practical Nurse in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.