Provider Demographics
NPI:1114286762
Name:ZIEGLER, TANIA DARLENE (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:DARLENE
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5151 BABCOCK ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4610
Mailing Address - Country:US
Mailing Address - Phone:321-567-7760
Mailing Address - Fax:321-567-7761
Practice Address - Street 1:5151 BABCOCK ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4610
Practice Address - Country:US
Practice Address - Phone:321-567-7760
Practice Address - Fax:321-567-7761
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
FLME128779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIQ354ZMedicare PIN