Provider Demographics
NPI:1013600287
Name:PODLASEK, TAMI (ARNP)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:PODLASEK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SEMINOLE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2522
Mailing Address - Country:US
Mailing Address - Phone:727-517-6329
Mailing Address - Fax:
Practice Address - Street 1:9555 SEMINOLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2522
Practice Address - Country:US
Practice Address - Phone:727-517-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine