Provider Demographics
NPI:1205872603
Name:MARSH, TAMARA A (DPM)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 BACKWATER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-4984
Mailing Address - Country:US
Mailing Address - Phone:850-899-3260
Mailing Address - Fax:
Practice Address - Street 1:147 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1871
Practice Address - Country:US
Practice Address - Phone:850-899-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2869213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340191000Medicaid
FL58902ZMedicare ID - Type Unspecified
FL340191000Medicaid
FL4122830001Medicare NSC