Healthcare Provider Details

I. General information

NPI: 1174574941
Provider Name (Legal Business Name): REBECCA CLARE TUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/17/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RIDGE CENTER DR STE 203
DAVENPORT FL
33837-6416
US

IV. Provider business mailing address

229 W LAKE SUMMIT DR
WINTER HAVEN FL
33884-1528
US

V. Phone/Fax

Practice location:
  • Phone: 863-667-6647
  • Fax: 312-276-8889
Mailing address:
  • Phone: 863-667-6647
  • Fax: 312-276-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35077947
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036124020
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036124020
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME138354
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME138354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: