Provider Demographics
NPI:1982030896
Name:FEHR, TAMARA L (PA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:FEHR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3291 WOODS EDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1301
Practice Address - Country:US
Practice Address - Phone:239-434-8565
Practice Address - Fax:239-434-8569
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP959328OtherOPTIMUM
FLY0JZ0OtherBCBS OF FL
FL4173135OtherAETNA
FL398588OtherAVMED
FL013442400Medicaid
FL1227519OtherWELLCARE
FLP1020870OtherFREEDOM
FL2108944OtherCIGAN
FLP01237339OtherRAILROAD MCR
FL013442400Medicaid