MEDICARE: TAMARA LE BLANC RT

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	227800000X	Certified Respiratory Therapist		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RT11616	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1962126557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA LE BLANC RT

Provider Business Mailing Address
First Line	:	PO BOX 290370
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33329-0370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7595 SW 33RD ST
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7708
Country	:	US
Telephone Number	:	954-262-6387
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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Directions to “ TAMARA LE BLANC RT” Practice Location

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