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General NPI Number Information
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NPI Number | 1972061570
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Entity Type | Individual
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Provider Name | SUZANA TANIMOTO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 77 8TH ST S STE B
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City | NAPLES
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State | FL
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Zip | 34102-6111
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Country | US
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Telephone | 239-325-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 77 8TH ST S STE B
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City | NAPLES
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State | FL
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Zip | 34102-6111
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Country | US
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Telephone | 239-325-2015
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PA9111967
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | PA9111967
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License Number State | FL
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