Provider Demographics
NPI:1518132802
Name:CRIST, TAMALA K (LMT)
Entity Type:Individual
Prefix:
First Name:TAMALA
Middle Name:K
Last Name:CRIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAMALA
Other - Middle Name:K
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:403 ANASTASIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:904-825-0569
Mailing Address - Fax:
Practice Address - Street 1:403 ANASTASIA BLVD
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080
Practice Address - Country:US
Practice Address - Phone:904-825-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist