Healthcare Provider Details

I. General information

NPI: 1942143185
Provider Name (Legal Business Name): PRIYA TANEJA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 62ND BLVD
GAINESVILLE FL
32607-2083
US

IV. Provider business mailing address

23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-8211
  • Fax: 352-373-7594
Mailing address:
  • Phone: 386-454-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: