Individual
TAMMERA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1969 WESTPOINTE CIR, ORLANDO, FL 32835
(407) 960-0192
Mailing address
1969 WESTPOINTE CIR, ORLANDO, FL 32835-8183
(407) 960-0192
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
832107134
—
FL
Enumeration date
10/17/2018
Last updated
07/25/2019
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