Healthcare Provider Details

I. General information

NPI: 1245247014
Provider Name (Legal Business Name): TAMBERLY FORD MCCARUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

IV. Provider business mailing address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4190
  • Fax: 407-303-4191
Mailing address:
  • Phone: 407-303-4190
  • Fax: 407-303-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME54599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: