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NPI Code Detail

MEDICARE: DARLENE TAN LMT

MEDICARE:   DARLENE  TAN  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist

General Provider Information

NPI Number : 1336912963
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARLENE TAN LMT
Provider Business Mailing Address
First Line : 6144 GAZEBO PARK PL S STE 101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-1086
Country : US
Telephone Number : 904-260-3011
Fax Number :
Provider Business Practice Location Address
First Line : 6144 GAZEBO PARK PL S STE 101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-1086
Country : US
Telephone Number : 904-260-3011
Fax Number : 904-260-4849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2023
Last Update Date : 11/06/2023

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Directions to “ DARLENE TAN LMT” Practice Location

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