MEDICARE: TAMERA SANSONE P.A.-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	363AM0700X	Medical Physician Assistant	PA3637	FL

General Provider Information

NPI Number	:	1760503130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMERA SANSONE P.A.-C

Provider Business Mailing Address
First Line	:	3075 E COMMERCIAL BLVD # 1A
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-491-6200
Fax Number	:	954-491-6419

Provider Business Practice Location Address
First Line	:	3075 E COMMERCIAL BLVD # 1A
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-491-6200
Fax Number	:	954-491-6419

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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