Healthcare Provider Details

I. General information

NPI: 1609429794
Provider Name (Legal Business Name): TANVI A PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 NEWBERRY RD STE 3
GAINESVILLE FL
32607-2822
US

IV. Provider business mailing address

4881 NW 8TH AVE STE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-2222
  • Fax: 352-374-8050
Mailing address:
  • Phone: 352-416-1082
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003274
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: