Healthcare Provider Details

I. General information

NPI: 1326461773
Provider Name (Legal Business Name): TAMELA SWANSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 08/30/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 KINGSLEY AVE STE 136
ORANGE PARK FL
32073-4547
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 904-458-7780
  • Fax:
Mailing address:
  • Phone: 239-223-2751
  • Fax: 904-253-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9194805
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9194805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: