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NPI Code Detail

MEDICARE: TAMMY MORAN MCCONVILLE PA-C

MEDICARE: TAMMY MORAN MCCONVILLE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant560WV
2363A00000XPhysician AssistantPA91041FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134227754
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY MORAN MCCONVILLE PA-C
Provider Business Mailing Address
First Line : 305 MEMORIAL MED PKWY STE 308
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5137
Country : US
Telephone Number : 386-231-3600
Fax Number :
Provider Business Practice Location Address
First Line : 305 MEMORIAL MED PKWY STE 308
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5137
Country : US
Telephone Number : 386-231-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/21/2022

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Directions to “ TAMMY MORAN MCCONVILLE PA-C” Practice Location

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