Provider Demographics
NPI:1710911839
Name:WRIGHT, TAMARA ALICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ALICIA
Last Name:WRIGHT
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 1:4340 NEWBERRY RD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2557
Mailing Address - Country:US
Mailing Address - Phone:352-372-9414
Mailing Address - Fax:352-271-5393
Practice Address - Street 1:4340 NEWBERRY RD.
Practice Address - Street 2:SUITE 301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2557
Practice Address - Country:US
Practice Address - Phone:352-372-9414
Practice Address - Fax:352-271-5393
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292902300Medicaid
FL292902300Medicaid
Q13808Medicare UPIN
FLU2462WMedicare PIN