Provider Demographics
NPI:1033174073
Name:BAKALOVA HRISTOV, TZONKA B (MD)
Entity Type:Individual
Prefix:
First Name:TZONKA
Middle Name:B
Last Name:BAKALOVA HRISTOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0868
Mailing Address - Country:US
Mailing Address - Phone:772-286-0338
Mailing Address - Fax:
Practice Address - Street 1:421 SE OSCEOLA ST
Practice Address - Street 2:STE 3
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2505
Practice Address - Country:US
Practice Address - Phone:772-286-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81363207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29032OtherBCBS OF FLORIDA
FL260491400Medicaid
FLH71901Medicare UPIN
FL260491400Medicaid