Individual
MS. TAMMY D GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9401 SW DISCOVERY WAY STE 201, PORT SAINT LUCIE, FL 34987-2381
(772) 288-2400
Mailing address
1050 SE MONTEREY RD STE 400, STUART, FL 34994-4512
(772) 288-2400
(772) 419-0143
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA9111653
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11544101
CAQH ID
FL
01
—
KU584
MEDICARE
FL
Enumeration date
01/27/2006
Last updated
09/27/2023
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