Provider Demographics
NPI:1861078115
Name:MCEWEN, TAMIA ANTIONETTE (CRPS)
Entity type:Individual
Prefix:DR
First Name:TAMIA
Middle Name:ANTIONETTE
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 STOCKBRIDGE SQ SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4221
Mailing Address - Country:US
Mailing Address - Phone:772-217-7371
Mailing Address - Fax:
Practice Address - Street 1:2507 STOCKBRIDGE SQ SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4221
Practice Address - Country:US
Practice Address - Phone:772-217-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100546-A175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist