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General NPI Number Information
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NPI Number | 1245850379
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Entity Type | Individual
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Provider Name | MAGGIE TZIVANIS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2020
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Last Update Date | 04/18/2020
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Provider Practice Location Address
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Address Line | 1954 SW GATLIN BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-2722
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Country | US
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Telephone | 772-224-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 4424 MAIN ST APT 4055
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City | JUPITER
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State | FL
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Zip | 33458-5360
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS58128
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License Number State | FL
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