Healthcare Provider Details

I. General information

NPI: 1972640985
Provider Name (Legal Business Name): TAMMY L TOMBROFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY L TOMBROFF LCSW

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 1ST ST
ST AUGUSTINE FL
32084-2268
US

IV. Provider business mailing address

3013 FIRST STREET
ST AUGUSTINE FL
32084
US

V. Phone/Fax

Practice location:
  • Phone: 904-321-6049
  • Fax:
Mailing address:
  • Phone: 904-829-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7218
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: