Provider Demographics
NPI:1760263230
Name:MISHKEL, TAMARA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MISHKEL
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 1:1599 NW 9TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1310
Mailing Address - Country:US
Mailing Address - Phone:561-338-8884
Mailing Address - Fax:561-338-5230
Practice Address - Street 1:1599 NW 9TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1310
Practice Address - Country:US
Practice Address - Phone:561-338-8884
Practice Address - Fax:561-338-5230
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9118100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant