Provider Demographics
NPI:1205267218
Name:JETT-PARMER, TAMERA (PA-C)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:JETT-PARMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SERENITY WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2223
Mailing Address - Country:US
Mailing Address - Phone:410-363-0869
Mailing Address - Fax:
Practice Address - Street 1:10440 SHAKER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1200
Practice Address - Country:US
Practice Address - Phone:443-864-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant