MEDICARE: MRS. PAMELA RUTHANN TETLOW ARNP

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	163WP0200X	Pediatric Registered Nurse	ARNP 9197916	FL

General Provider Information

NPI Number	:	1629124730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA RUTHANN TETLOW ARNP

Provider Business Mailing Address
First Line	:	2071 N POINTE ALEXIS DR
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-2063
Country	:	US
Telephone Number	:	727-942-8461
Fax Number	:	727-942-8637

Provider Business Practice Location Address
First Line	:	7402 N 56TH ST
Second Line	:	906
City	:	TAMPA
State	:	FL
Zip	:	33617-7733
Country	:	US
Telephone Number	:	727-536-4119
Fax Number	:	727-538-5529

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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