Provider Demographics
NPI:1720372816
Name:TSO, TINA (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:TSO
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 1:320 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2744
Mailing Address - Country:US
Mailing Address - Phone:386-238-3254
Mailing Address - Fax:386-238-3255
Practice Address - Street 1:320 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2744
Practice Address - Country:US
Practice Address - Phone:386-238-3254
Practice Address - Fax:386-238-3255
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME113914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine