MEDICARE: COURTNEY SCAMARDO PA-C

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	363A00000X	Physician Assistant	PA09650	TX

General Provider Information

NPI Number	:	1356720130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY SCAMARDO PA-C

Provider Business Mailing Address
First Line	:	4919 MEMORIAL HWY STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7516
Country	:	US
Telephone Number	:	813-333-1512
Fax Number	:	813-333-1561

Provider Business Practice Location Address
First Line	:	2700 W ANDERSON LN STE 403
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1153
Country	:	US
Telephone Number	:	512-786-3498
Fax Number	:	512-243-7236

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	01/19/2024

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