Healthcare Provider Details

I. General information

NPI: 1306284716
Provider Name (Legal Business Name): TINA THUY VY O'SHEA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0294
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0294
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7943
  • Fax: 352-392-3498
Mailing address:
  • Phone: 352-273-7943
  • Fax: 352-392-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME131357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: