Provider Demographics
NPI:1740922814
Name:WILHITE, TAMMY MARIE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:WILHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 US HIGHWAY 19 STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3942
Mailing Address - Country:US
Mailing Address - Phone:727-937-6551
Mailing Address - Fax:727-942-7200
Practice Address - Street 1:2435 US HIGHWAY 19 STE 100
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3942
Practice Address - Country:US
Practice Address - Phone:727-937-6551
Practice Address - Fax:727-942-7200
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5806156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician