Provider Demographics
NPI:1164298857
Name:TOMIC, MARIJA MAYA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:MAYA
Last Name:TOMIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-4052
Mailing Address - Country:US
Mailing Address - Phone:330-212-9320
Mailing Address - Fax:
Practice Address - Street 1:308 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4716
Practice Address - Country:US
Practice Address - Phone:352-726-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty