Provider Demographics
NPI:1598830242
Name:STEWART, TAMMIE M (CFM)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8123 RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-7057
Mailing Address - Country:US
Mailing Address - Phone:727-845-5777
Mailing Address - Fax:727-841-8910
Practice Address - Street 1:8123 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-7057
Practice Address - Country:US
Practice Address - Phone:727-845-5777
Practice Address - Fax:727-841-8910
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC08473050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1304110001Medicare NSC