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General NPI Number Information
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NPI Number | 1740922814
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Entity Type | Individual
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Provider Name | TAMMY MARIE WILHITE
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Gender | Female
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 2435 US HIGHWAY 19 STE 100
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City | HOLIDAY
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State | FL
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Zip | 34691-3942
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Country | US
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Telephone | 727-937-6551
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Fax | 727-942-7200
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Provider Business Mailing Address
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Address Line | 2435 US HIGHWAY 19 STE 100
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City | HOLIDAY
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State | FL
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Zip | 34691-3942
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Country | US
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Telephone | 727-937-6551
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Fax | 727-942-7200
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO5806
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License Number State | FL
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