1629124730 NPI number — MRS. PAMELA RUTHANN TETLOW ARNP

Table of content: MRS. PAMELA RUTHANN TETLOW ARNP (NPI 1629124730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629124730 NPI number — MRS. PAMELA RUTHANN TETLOW ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETLOW
Provider First Name:
PAMELA
Provider Middle Name:
RUTHANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629124730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2071 N POINTE ALEXIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARPON SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34689-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-942-8461
Provider Business Mailing Address Fax Number:
727-942-8637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7402 N 56TH ST
Provider Second Line Business Practice Location Address:
906
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33617-7733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-536-4119
Provider Business Practice Location Address Fax Number:
727-538-5529
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0200X , with the licence number:  ARNP 9197916 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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