MEDICARE: JACKSON CHIO TAN M.D., PH.D., P.T.

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	225400000X	Rehabilitation Practitioner	ME0071587	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	ME71587	FL

General Provider Information

NPI Number	:	1649303934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON CHIO TAN M.D., PH.D., P.T.

Provider Business Mailing Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:	904-260-3170

Provider Business Practice Location Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:	904-260-3170

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	11/05/2023

Similar Medicare Providers

1922114065 — MRS. ROCHELLE GROSPE MIRANDA P.T.
Practice Location Address:

6144 GAZEBO PARK PL S STE 211
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-551-3122
Practice Fax: 904-551-3481

1164507422 — OCCUPATIONAL AND REHABILITATION CENTER PA
Practice Location Address:

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-260-3011
Practice Fax: 904-260-3170

1063545341 — DR. CARLOS ACOSTA OTEYZA M.D.
Practice Location Address:

6144 GAZEBO PARK PL S STE 211
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-551-3122
Practice Fax: 904-551-3481

1518730142 — CASSANDRA JENNINGS LMT, LPN
Practice Location Address:

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-260-3011
Practice Fax:

1336912963 — DARLENE TAN LMT
Practice Location Address:

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-260-3011
Practice Fax: 904-260-4849

1598538126 — VIRGINIE BALISI RPT
Practice Location Address:

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE, FL
32257-1086

Practice Phone: 904-260-3011
Practice Fax: 904-260-4849

Directions to “ JACKSON CHIO TAN M.D., PH.D., P.T.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.