MEDICARE: MS. TIA TAMERA STEWARD

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	390200000X	Student in an Organized Health Care Education/Training Program		FL

General Provider Information

NPI Number	:	1235814252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIA TAMERA STEWARD

Provider Business Mailing Address
First Line	:	11212 MOONVALLEY WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1551
Country	:	US
Telephone Number	:	813-787-6078
Fax Number	:

Provider Business Practice Location Address
First Line	:	11212 MOONVALLEY WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1551
Country	:	US
Telephone Number	:	813-787-6078
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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