Healthcare Provider Details

I. General information

NPI: 1245401504
Provider Name (Legal Business Name): TAMARA DUCKWORTH WARNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 89TH BLVD
GAINESVILLE FL
32606
US

IV. Provider business mailing address

4101 NW 89TH BLVD
GAINESVILLE FL
32606-3813
US

V. Phone/Fax

Practice location:
  • Phone: 352-627-0456
  • Fax:
Mailing address:
  • Phone: 352-627-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 7353
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 7353
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY 7353
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: