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General NPI Number Information
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NPI Number | 1649325150
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Entity Type | Individual
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Provider Name | TAMMY M. PETERS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11639 QUAIL RUN DR
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City | FORT MYERS
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State | FL
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Zip | 33908-2145
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Country | US
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Telephone | 239-245-8192
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Fax | 239-245-8192
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Provider Business Mailing Address
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Address Line | 11639 QUAIL RUN DR
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City | FORT MYERS
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State | FL
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Zip | 33908-2145
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Country | US
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Telephone | 239-245-8192
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Fax | 239-245-8192
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 46-8013727279-2
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License Number State | FL
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