Organization
SMILEY ENTERPRISE OF TAMPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAPORSCHE QUINTELLA HOLMES (OWNER)
(352) 777-3898
Entity
Organization
Contact information
Practice address
8105 CRANMOORE PL APT 101, TAMPA, FL 33610-8696
(352) 777-3898
Mailing address
8105 CRANMOORE PL APT 101, TAMPA, FL 33610-8696
(352) 777-3898
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106300000
—
FL
Enumeration date
08/14/2020
Last updated
08/14/2020
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