Provider Demographics
NPI:1285619940
Name:HOWERTON, TAMMY (PA-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HOWERTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8100
Mailing Address - Fax:850-863-8548
Practice Address - Street 1:1045 US HIGHWAY 331 S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3379
Practice Address - Country:US
Practice Address - Phone:850-892-3366
Practice Address - Fax:833-451-2226
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109503363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080784401Medicaid
G30785Medicare UPIN
0055BYMedicare UPIN
TX080784401Medicaid