Provider Demographics
NPI:1043326184
Name:TZIVANIS, JAMES R (RPA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:TZIVANIS
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5672 W JUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-1632
Mailing Address - Country:US
Mailing Address - Phone:352-628-7026
Mailing Address - Fax:
Practice Address - Street 1:5915 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7565
Practice Address - Country:US
Practice Address - Phone:352-794-3872
Practice Address - Fax:352-794-3876
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000469363A00000X
FLPA9104839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB6897Medicare PIN
R55833Medicare UPIN