Provider Demographics
NPI:1285194316
Name:FANN-BIONDI, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:FANN-BIONDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3620
Mailing Address - Country:US
Mailing Address - Phone:850-656-1381
Mailing Address - Fax:
Practice Address - Street 1:2522 CAPITAL CIR NE STE 15
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4134
Practice Address - Country:US
Practice Address - Phone:850-553-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP0000775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist