Provider Demographics
NPI:1891394243
Name:FORT, TAMI COROMOTO (SA-C)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:COROMOTO
Last Name:FORT
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 GARDEN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3847
Mailing Address - Country:US
Mailing Address - Phone:786-647-4550
Mailing Address - Fax:
Practice Address - Street 1:3433 GARDEN AVE APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3847
Practice Address - Country:US
Practice Address - Phone:786-647-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-399246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant