MEDICARE: TAMARA GRIFFITH

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	2355S0801X	Speech-Language Assistant	SI1434	FL
2	235Z00000X	Speech-Language Pathologist	SA18255	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA18255	OTHER	FL	FLORIDA MEDICAL DOH LICENSE #
2	SI1434	OTHER	FL	FLORIDA MEDICAL LICENSE #

General Provider Information

NPI Number	:	1982894093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA GRIFFITH

Provider Business Mailing Address
First Line	:	11901 ABESS BLVD APT 3235
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6038
Country	:	US
Telephone Number	:	904-923-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 MOUNT VERNON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5417
Country	:	US
Telephone Number	:	407-810-2773
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	10/27/2023

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Directions to “ TAMARA GRIFFITH ” Practice Location

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