Provider Demographics
NPI:1275915811
Name:TARANTOLA DERMATOLOGY INC
Entity Type:Organization
Organization Name:TARANTOLA DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-439-5394
Mailing Address - Street 1:525 BRENT LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2003
Mailing Address - Country:US
Mailing Address - Phone:850-439-5394
Mailing Address - Fax:850-696-2613
Practice Address - Street 1:525 BRENT LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2003
Practice Address - Country:US
Practice Address - Phone:850-439-5394
Practice Address - Fax:850-696-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty