MEDICARE: MS. TAMARA PREPETIT BA

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	104100000X	Social Worker

Other Identifiers

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

General Provider Information

NPI Number	:	1417110867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA PREPETIT BA

Provider Business Mailing Address
First Line	:	7990 SW 117TH AVE STE 125
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3845
Country	:	US
Telephone Number	:	305-929-8705
Fax Number	:

Provider Business Practice Location Address
First Line	:	7990 SW 117TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3847
Country	:	US
Telephone Number	:	305-929-8705
Fax Number	:

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	12/05/2024

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