Individual
TAMARA THRELKELD PISTORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1033 N PARKWAY FRONTAGE RD, LAKELAND, FL 33803-0401
(863) 647-8011
(863) 647-8029
Mailing address
PO BOX 95004, LAKELAND, FL 33804-5004
(863) 680-7000
(863) 680-7420
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS0008614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264246800
—
FL
Enumeration date
07/12/2005
Last updated
06/26/2012
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