Provider Demographics
NPI:1508154956
Name:WOOD, TAMARA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MICHELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:911 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3239
Mailing Address - Country:US
Mailing Address - Phone:352-463-2374
Mailing Address - Fax:352-463-4507
Practice Address - Street 1:630 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-1705
Practice Address - Country:US
Practice Address - Phone:352-528-0587
Practice Address - Fax:352-463-2726
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003937900Medicaid
FLFM253ZMedicare Oscar/Certification