Organization
TLC PEDIATRIC & ADOLESCENT MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE REYNOLDS-LACY RN (OFFICE MANAGER)
(407) 380-9115
Entity
Organization
Contact information
Practice address
1834 N ALAFAYA TRL, SUITE A, ORLANDO, FL 32826-4743
(407) 380-9115
(407) 380-9189
Mailing address
1834 N ALAFAYA TRL, SUITE A, ORLANDO, FL 32826-4743
(407) 380-9115
(407) 380-9189
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97689
BCBS
FL
05
—
K8880
—
FL
Enumeration date
07/08/2006
Last updated
08/22/2020
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