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General NPI Number Information
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NPI Number | 1194382861
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Entity Type | Individual
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Provider Name | TANYA PAKZAD PLANTE OD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 702 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2617
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Country | US
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Telephone | 772-873-0037
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SE COURANCES DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-6662
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Country | US
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Telephone | 240-888-8032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5705
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License Number State | FL
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