NPI | 1629174578 |
---|---|
Former Name | TAMMY J VICARI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112219) |
Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: PA RN291664L) |
363AM0700X Physician Assistant, Medical (Licence: PA MA002095L) | |
Enumeration Date | 2006-09-16 |
Last Update Date | 2022-12-08 |