Provider Demographics
NPI:1831466382
Name:GOVE, TAMI
Entity Type:Individual
Prefix:MISS
First Name:TAMI
Middle Name:
Last Name:GOVE
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 1:6746 POINT HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8770
Mailing Address - Country:US
Mailing Address - Phone:303-717-9125
Mailing Address - Fax:
Practice Address - Street 1:515 N PARK AVE
Practice Address - Street 2:SUITE 201 B
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3634
Practice Address - Country:US
Practice Address - Phone:407-703-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316239528Medicaid