Provider Demographics
NPI:1396816765
Name:TARANTOLA, CRISTINA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:ISABEL
Last Name:TARANTOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112087207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014407000Medicaid
FL014407000Medicaid