Tanouye, Staci L

Tanouye, Staci L is an individual health care provider with primary practice located at 1361 13Th Ave S Ste &110&115 , Jacksonville Beach FL 32250-3233. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Tanouye, Staci L can be contacted via phone (904) 247-5514.

Contact Information

Primary practice address
1361 13Th Ave S Ste &110&115 Jacksonville Beach FL 32250-3233
Phone: (904) 247-5514
Fax: (904) 247-3363
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 52096 Minnesota
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME117299 Florida

Profile Details

NPI number 1679739775
LBN Legal business name Tanouye, Staci L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2008
Last updated Jun 22nd, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679739775 NPPES
Florida MEDICAID 010025600

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