Healthcare Provider Details

I. General information

NPI: 1720017361
Provider Name (Legal Business Name): TAMZIN A ROSENWASSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SALEM ST
LAFAYETTE IN
47904-2164
US

IV. Provider business mailing address

4411 BEE RIDGE ROAD PMB 309
SARASOTA FL
34233-5545
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-8000
  • Fax:
Mailing address:
  • Phone: 941-926-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME71744
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01057228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: