Provider Demographics
NPI:1033669049
Name:GIRALDO, TAMARA (PA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:GUARDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-971-3210
Mailing Address - Fax:954-971-3427
Practice Address - Street 1:4570 LYONS RD STE 110
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3481
Practice Address - Country:US
Practice Address - Phone:954-971-3210
Practice Address - Fax:954-971-3427
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109873363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019673300Medicaid