Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME140511 | FL |
NPI | 1245505478 |
---|---|
Provider Name | Tiffany R Tonismae |
First Address | St Petersburg, FL 33701-4619 |
Second Address | Brandon, FL 33511-5779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2012 |
Last Update Date | 06/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102693500 | (05) | FL |