MEDICARE: MS. PAMELA K GRAHAM NP

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	363LW0102X	Women's Health Nurse Practitioner	2896362	FL

General Provider Information

NPI Number	:	1770661928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA K GRAHAM NP

Provider Business Mailing Address
First Line	:	7777 N UNIVERSITY DR STE 102
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-6106
Country	:	US
Telephone Number	:	954-720-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 N UNIVERSITY DR STE 102
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-6106
Country	:	US
Telephone Number	:	954-720-7777
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/16/2015

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