Provider Demographics
NPI:1720017361
Name:ROSENWASSER, TAMZIN A
Entity Type:Individual
Prefix:
First Name:TAMZIN
Middle Name:A
Last Name:ROSENWASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 BEE RIDGE ROAD
Mailing Address - Street 2:PMB 309
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5545
Mailing Address - Country:US
Mailing Address - Phone:941-926-6553
Mailing Address - Fax:
Practice Address - Street 1:1500 SALEM ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2164
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71744207N00000X
IN01057228A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200830950Medicaid
IN9294464OtherPHCS PID NUMBER
IN000000487140OtherANTHEM PROVIDER NUMBER
FLHQ199ZOtherMEDICARE PTAN
FLHQ199ZOtherMEDICARE PTAN
IN9294464OtherPHCS PID NUMBER
IN815500187Medicare PIN
INP00367564Medicare PIN