Provider Demographics
NPI:1598752586
Name:BEZANSON, TAMMARA (APRN)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:
Last Name:BEZANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:12700 CREEKSIDE LN
Practice Address - Street 2:STE 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-600-7808
Practice Address - Fax:239-600-7809
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2826072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0J2AOtherFL BC
FL304995700Medicaid
FLP73595Medicare UPIN
FLCY969XMedicare PIN
FLCY969ZMedicare PIN