Provider Demographics
NPI:1083853444
Name:DRAGON, TAMAR (PA-C)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:DRAGON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-649-8585
Mailing Address - Fax:407-649-0151
Practice Address - Street 1:2706 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4215
Practice Address - Country:US
Practice Address - Phone:407-649-8585
Practice Address - Fax:407-649-0151
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM376YMedicare PIN
FL1588618037Medicare NSC