Provider Demographics
NPI:1770661928
Name:GRAHAM, PAMELA K (NP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:K
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 N UNIVERSITY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6106
Mailing Address - Country:US
Mailing Address - Phone:954-720-7777
Mailing Address - Fax:
Practice Address - Street 1:7777 N UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6106
Practice Address - Country:US
Practice Address - Phone:954-720-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2896362363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03137Medicare UPIN