Provider Demographics
NPI:1235855685
Name:RHODES, TAMICA D
Entity type:Individual
Prefix:MRS
First Name:TAMICA
Middle Name:D
Last Name:RHODES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMICA
Other - Middle Name:D
Other - Last Name:PETTIGREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1061 MEDICAL CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8225
Mailing Address - Country:US
Mailing Address - Phone:386-456-3852
Mailing Address - Fax:833-972-5940
Practice Address - Street 1:1061 MEDICAL CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8225
Practice Address - Country:US
Practice Address - Phone:386-456-3852
Practice Address - Fax:833-972-5940
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221924367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife