Provider Demographics
NPI:1114087723
Name:TIGLEY, THOM JUEL ESPINA (MD)
Entity Type:Individual
Prefix:
First Name:THOM JUEL
Middle Name:ESPINA
Last Name:TIGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10006 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE 443
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2595
Mailing Address - Country:US
Mailing Address - Phone:813-676-3636
Mailing Address - Fax:
Practice Address - Street 1:10006 CROSS CREEK BLVD
Practice Address - Street 2:SUITE 443
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2595
Practice Address - Country:US
Practice Address - Phone:813-676-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC05032207Q00000X
FLME101128207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000294400Medicaid
FLAM456ZMedicare PIN