Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | TRN17336 | FL |
N | 111NI0900X | Internist | TRN17336 | FL |
N | 207RA0201X | Internist - Allergy & Immunology | 269327 | MA |
Y | 2080P0201X | Pediatric Allergist | ME130207 | FL |
NPI | 1649530395 |
---|---|
Provider Name | Tanvi Rajiv Patel |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 22/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101177900 | (05) | FL |