Healthcare Provider Details

I. General information

NPI: 1629124730
Provider Name (Legal Business Name): PAMELA RUTHANN TETLOW ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 N 56TH ST 906
TAMPA FL
33617-7733
US

IV. Provider business mailing address

2071 N POINTE ALEXIS DR
TARPON SPRINGS FL
34689-2063
US

V. Phone/Fax

Practice location:
  • Phone: 727-536-4119
  • Fax: 727-538-5529
Mailing address:
  • Phone: 727-942-8461
  • Fax: 727-942-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberARNP 9197916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: