Provider Demographics
NPI:1952996472
Name:GALLARDO, TAMARA (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 MYSTIC POINTER DR.
Mailing Address - Street 2:1704
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4530
Mailing Address - Country:US
Mailing Address - Phone:786-564-9679
Mailing Address - Fax:
Practice Address - Street 1:3530 MYSTIC POINTER DR.
Practice Address - Street 2:1704
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4530
Practice Address - Country:US
Practice Address - Phone:786-564-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011672363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care