Provider Demographics
NPI:1891913257
Name:TANTRANOND, PANEE (MD)
Entity Type:Individual
Prefix:MS
First Name:PANEE
Middle Name:
Last Name:TANTRANOND
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 1:1152 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2221
Mailing Address - Country:US
Mailing Address - Phone:727-867-0523
Mailing Address - Fax:
Practice Address - Street 1:3033 WINKLER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37174261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA