Healthcare Provider Details

I. General information

NPI: 1982894093
Provider Name (Legal Business Name): TAMARA GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 MOUNT VERNON ST
ORLANDO FL
32803-5417
US

IV. Provider business mailing address

11901 ABESS BLVD APT 3235
JACKSONVILLE FL
32225-6038
US

V. Phone/Fax

Practice location:
  • Phone: 407-810-2773
  • Fax:
Mailing address:
  • Phone: 904-923-5943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI1434
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: