Healthcare Provider Details

I. General information

NPI: 1982741724
Provider Name (Legal Business Name): TAMARA S. MICHAEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 N CLYDE MORRIS BLVD STE 2
DAYTONA BEACH FL
32117-5500
US

IV. Provider business mailing address

901S S DIXIE FWY SUITE 905
NEW SMYRNA BEACH FL
32168
US

V. Phone/Fax

Practice location:
  • Phone: 865-186-4013
  • Fax: 386-256-3008
Mailing address:
  • Phone: 386-957-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012147
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704170196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: