Provider Demographics
NPI:1447543608
Name:MELIGAN, TAMARA KAY (PAC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:MELIGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:KAY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8000
Mailing Address - Fax:850-474-8083
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8572
Practice Address - Fax:850-474-8016
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105949363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant