Provider Demographics
NPI:1447461736
Name:RICHARDS, TAMARA NASSAR (MD)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NASSAR
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 DON WICKHAM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1980
Mailing Address - Country:US
Mailing Address - Phone:318-272-8406
Mailing Address - Fax:352-241-7035
Practice Address - Street 1:1900 DON WICKHAM DR STE 120
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1980
Practice Address - Country:US
Practice Address - Phone:352-241-7050
Practice Address - Fax:352-241-7035
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128994207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4Q388F600OtherMEDICARE - PTAN
LA50985Medicaid