Provider Demographics
NPI:1124811302
Name:FITZ, INDIA TAMAYA
Entity type:Individual
Prefix:
First Name:INDIA
Middle Name:TAMAYA
Last Name:FITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-6902
Mailing Address - Country:US
Mailing Address - Phone:850-755-0018
Mailing Address - Fax:850-755-0018
Practice Address - Street 1:3416 BLUE JAY DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-6902
Practice Address - Country:US
Practice Address - Phone:850-755-0018
Practice Address - Fax:850-755-0018
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039827363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology