Healthcare Provider Details

I. General information

NPI: 1427864610
Provider Name (Legal Business Name): TAMARA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 ALOMA AVE
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

14418 BRIDGEWATER CROSSINGS BLVD
WINDERMERE FL
34786-3204
US

V. Phone/Fax

Practice location:
  • Phone: 407-284-7454
  • Fax:
Mailing address:
  • Phone: 407-284-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: