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NPI Code Detail

MEDICARE: PETREA PALMER TOMKO PA-C

MEDICARE: PETREA PALMER TOMKO 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
1207Q00000XFamily Medicine PhysicianPA9105006FL

General Provider Information

NPI Number : 1689901894
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETREA PALMER TOMKO PA-C
Provider Business Mailing Address
First Line : 4601 SPANISH TRL
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-5039
Country : US
Telephone Number : 850-969-2001
Fax Number : 850-433-8940
Provider Business Practice Location Address
First Line : 4601 SPANISH TRL
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-5039
Country : US
Telephone Number : 850-969-2001
Fax Number : 850-433-8940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2009
Last Update Date : 02/10/2010

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Directions to “ PETREA PALMER TOMKO PA-C” Practice Location

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