MEDICARE: PAMELA PETERS

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
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1215523857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA PETERS

Provider Business Mailing Address
First Line	:	5158 BELLE CHASE CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4253
Country	:	US
Telephone Number	:	717-203-2354
Fax Number	:

Provider Business Practice Location Address
First Line	:	5158 BELLE CHASE CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4253
Country	:	US
Telephone Number	:	717-203-2354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “ PAMELA PETERS ” Practice Location

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