MEDICARE: TAMMY WINSTON

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	1041C0700X	Clinical Social Worker	LC50078613	DC

General Provider Information

NPI Number	:	1700154499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY WINSTON

Provider Business Mailing Address
First Line	:	5164 NW 66TH LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2170
Country	:	US
Telephone Number	:	917-536-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	5164 NW 66TH LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2170
Country	:	US
Telephone Number	:	917-536-5255
Fax Number	:

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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