Provider Demographics
NPI:1508576935
Name:BENDER, TAMERRICA
Entity Type:Individual
Prefix:
First Name:TAMERRICA
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 ARLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5567
Mailing Address - Country:US
Mailing Address - Phone:228-870-5898
Mailing Address - Fax:
Practice Address - Street 1:12501 ARLEDGE ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5567
Practice Address - Country:US
Practice Address - Phone:228-870-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide