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General NPI Number Information
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NPI Number | 1184166779
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Entity Type | Individual
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Provider Name | TAMARA WILSON CISNERO M.D
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Gender | Female
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1741 E NINE MILE RD STE 5
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City | PENSACOLA
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State | FL
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Zip | 32514-5478
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Country | US
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Telephone | 850-462-9387
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Fax | 850-462-9389
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Provider Business Mailing Address
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Address Line | 71 CALLE SANTA CRUZ APT 7A
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City | BAYAMON
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State | PR
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Zip | 00961-6926
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Country | US
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Telephone | 585-472-1766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 023999
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1676
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License Number State | FL
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