Provider Demographics
NPI:1982030896
Name:FEHR, TAMARA L (PA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:FEHR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:727-441-1508
Mailing Address - Fax:
Practice Address - Street 1:1035 PIPER BLVD # 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1449
Practice Address - Country:US
Practice Address - Phone:239-465-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP959328OtherOPTIMUM
FLY0JZ0OtherBCBS OF FL
FL4173135OtherAETNA
FL398588OtherAVMED
FL013442400Medicaid
FL1227519OtherWELLCARE
FLP1020870OtherFREEDOM
FL2108944OtherCIGAN
FLP01237339OtherRAILROAD MCR
FL013442400Medicaid