MEDICARE: DR. TINA NIGAM MD

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
1	2084V0102X	Vascular Neurology Physician	ME169423	FL
2	2084N0400X	Neurology Physician	ME169423	FL
3	2084V0102X	Vascular Neurology Physician	4301509003	MI

General Provider Information

NPI Number	:	1619437084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA NIGAM MD

Provider Business Mailing Address
First Line	:	1329 SW 16TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-559-5051
Fax Number	:	352-265-8018

Provider Business Practice Location Address
First Line	:	8 MIRROR LAKE DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-3101
Country	:	US
Telephone Number	:	386-673-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	01/15/2026

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