Provider Demographics
NPI:1982741724
Name:MICHAEL, TAMARA S (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:MICHAEL
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 1:1667 N CLYDE MORRIS BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:865-186-4013
Mailing Address - Fax:386-256-3008
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:865-186-4013
Practice Address - Fax:386-256-3008
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170196363L00000X
FLAPRN11012147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP06889Medicare UPIN