Healthcare Provider Details

I. General information

NPI: 1497809834
Provider Name (Legal Business Name): DARYL R TANSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-2062
  • Fax: 239-424-4186
Mailing address:
  • Phone: 239-343-2062
  • Fax: 239-424-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM-15586
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number69030
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301067776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: