Provider Demographics
NPI:1457788713
Name:ASHLEY, TAMARA KENISHA (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KENISHA
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E MCBERRY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6415
Mailing Address - Country:US
Mailing Address - Phone:813-263-8823
Mailing Address - Fax:
Practice Address - Street 1:3200 E MCBERRY ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6415
Practice Address - Country:US
Practice Address - Phone:813-263-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12340181744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management