Healthcare Provider Details

I. General information

NPI: 1083853444
Provider Name (Legal Business Name): TAMAR DRAGON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 REW CIR
OCOEE FL
34761-4215
US

IV. Provider business mailing address

2706 REW CIR
OCOEE FL
34761-4215
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-8585
  • Fax: 407-649-0151
Mailing address:
  • Phone: 407-649-8585
  • Fax: 407-649-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: