Provider Demographics
NPI:1033397989
Name:HUNTER, TANYA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:E
Last Name:HUNTER
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 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:SUITE 521
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9680
Mailing Address - Country:US
Mailing Address - Phone:904-807-9747
Mailing Address - Fax:904-807-9746
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:SUITE 521
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-807-9747
Practice Address - Fax:904-807-9746
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280423900Medicaid
FL20039OtherBCBS
GA486565967ZMedicaid
P00604793Medicare PIN
FL280423900Medicaid