Healthcare Provider Details

I. General information

NPI: 1750809414
Provider Name (Legal Business Name): TAMARA BERGAMO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA BATEH

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S TAMIAMI TRL
SARASOTA FL
34239-2930
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8791
  • Fax: 941-917-8793
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: