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General NPI Number Information
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NPI Number | 1942053467
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Entity Type | Individual
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Provider Name | ZOE TAN PEREDA MD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 2400 HARBOR BLVD STE 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5038
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Country | US
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Telephone | 941-629-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 10661 JACATREE CT
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-7345
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Country | US
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Telephone | 239-202-3941
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1737
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License Number State | FL
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