Tiara Lei Funkhouser, PA

NPI #1306578786 in Yulee, Florida

Provider Information

NPI Number: 1306578786
Entity Type: Individual
Name: Tiara Lei Funkhouser, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Jun 25, 2022
Last Updated: Oct 21, 2022

Practice Location

Address: 463380 STATE ROAD 200 UNIT B
City: Yulee
State: Florida
ZIP Code: 32097-3240
Phone: (904) 500-9808

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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