Healthcare Provider Details

I. General information

NPI: 1114669074
Provider Name (Legal Business Name): TANNICE ALAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANNICE FOGARTHY

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 CYPRESS VILLAGE BLVD STE A
RUSKIN FL
33573-6841
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-3002
  • Fax: 888-720-3963
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME182506
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: