Provider Demographics
NPI:1194230979
Name:TANKSLEY, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:TANKSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM AP
Mailing Address - Street 1:PO BOX 25794
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 SWIFT RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6578
Practice Address - Country:US
Practice Address - Phone:941-350-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist