Provider Demographics
NPI:1992423669
Name:PEDROSO MARQUEZ, TAMARA (APRN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:PEDROSO MARQUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 ENSENADA DR FL 32825
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8617
Mailing Address - Country:US
Mailing Address - Phone:131-588-3954
Mailing Address - Fax:
Practice Address - Street 1:1633 ENSENADA DR FL 32825
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8617
Practice Address - Country:US
Practice Address - Phone:131-588-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF07221761Medicaid