MEDICARE: TAMARA MOORE

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	172V00000X	Community Health Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891236642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MOORE

Provider Business Mailing Address
First Line	:	6381 SW 10TH ST
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6381 SW 10TH ST
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2717
Country	:	US
Telephone Number	:	954-630-5741
Fax Number	:

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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Directions to “ TAMARA MOORE ” Practice Location

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