Provider Demographics
NPI:1699731687
Name:MCKELVY, TAMARA L (FNP)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:L
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:850-863-8219
Mailing Address - Fax:850-863-8548
Practice Address - Street 1:1332 N FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-1749
Practice Address - Country:US
Practice Address - Phone:850-634-6193
Practice Address - Fax:855-741-3080
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q64969Medicare UPIN