MEDICARE: TAMARA L ANTOINE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11007824	FL

General Provider Information

NPI Number	:	1053078436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA L ANTOINE APRN

Provider Business Mailing Address
First Line	:	9841 NW 37TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2808
Country	:	US
Telephone Number	:	954-851-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	9841 NW 37TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2808
Country	:	US
Telephone Number	:	954-851-5456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2021
Last Update Date	:	11/20/2021

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Directions to “ TAMARA L ANTOINE APRN” Practice Location

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