Provider Demographics
NPI:1932451408
Name:SHOWALTER, TAMARA KERBS (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KERBS
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:KERBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:86 W UNDERWOOD ST
Mailing Address - Street 2:MP 80
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:888-912-3648
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:86 W UNDERWOOD ST
Practice Address - Street 2:MP 80
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:888-912-3648
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9280551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015745800Medicaid
FLARNP9280551OtherMEDICAL LICENSE
FLARNP9280551OtherMEDICAL LICENSE