Provider Demographics
NPI:1710546692
Name:ST LOUIS, TAMMY (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ST LOUIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9602
Mailing Address - Country:US
Mailing Address - Phone:352-669-3175
Mailing Address - Fax:352-669-3640
Practice Address - Street 1:390 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9602
Practice Address - Country:US
Practice Address - Phone:352-669-3175
Practice Address - Fax:352-669-3640
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant