Healthcare Provider Details

I. General information

NPI: 1164004347
Provider Name (Legal Business Name): TJ HAND AND UPPER EXTREMITY SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 3RD CT STE 5
PLANTATION FL
33317-2830
US

IV. Provider business mailing address

PO BOX 121041
FORT LAUDERDALE FL
33312-0009
US

V. Phone/Fax

Practice location:
  • Phone: 954-703-1987
  • Fax: 800-507-3145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMARA JOHN
Title or Position: OWNER
Credential: MD
Phone: 585-802-7527