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NPI Code Detail

MEDICARE: TY L TVEDTEN D.O.

MEDICARE: TY L TVEDTEN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS6788FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180960OTHERFLBLUE CROSS

General Provider Information

NPI Number : 1285626382
Entity Type Code : Individual
Provider Name (Legal Business Name) : TY L TVEDTEN D.O.
Provider Business Mailing Address
First Line : 12020 SEMINOLE BLVD
Second Line :
City : LARGO
State : FL
Zip : 33778-2805
Country : US
Telephone Number : 727-588-9572
Fax Number : 727-584-3832
Provider Business Practice Location Address
First Line : 12020 SEMINOLE BLVD
Second Line :
City : LARGO
State : FL
Zip : 33778-2805
Country : US
Telephone Number : 727-588-9572
Fax Number : 727-584-3832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 07/08/2007

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Directions to “ TY L TVEDTEN D.O.” Practice Location

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