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NPI Code Detail

MEDICARE: MS. TAMMY D GAINES PA-C

MEDICARE: MS. TAMMY D GAINES 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
1363A00000XPhysician Assistant
2363AM0700XMedical Physician AssistantPA9111653FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KU584OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
211544101OTHERFLCAQH ID
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619948775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMMY D GAINES PA-C
Provider Business Mailing Address
First Line : 1050 SE MONTEREY RD STE 400
Second Line :
City : STUART
State : FL
Zip : 34994-4512
Country : US
Telephone Number : 772-288-2400
Fax Number : 772-419-0143
Provider Business Practice Location Address
First Line : 9401 SW DISCOVERY WAY STE 201
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-2381
Country : US
Telephone Number : 772-288-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 09/27/2023

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