Provider Demographics
NPI:1922700525
Name:TANHEALTH LLC
Entity Type:Organization
Organization Name:TANHEALTH LLC
Other - Org Name:TANHEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOVANIE SERGE
Authorized Official - Middle Name:KEUSSEU
Authorized Official - Last Name:TANKEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MS,MPH,MBA,CHES
Authorized Official - Phone:757-292-0515
Mailing Address - Street 1:8220 SW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6628
Mailing Address - Country:US
Mailing Address - Phone:757-292-0515
Mailing Address - Fax:617-362-2906
Practice Address - Street 1:790 NW 107TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3100
Practice Address - Country:US
Practice Address - Phone:757-292-0515
Practice Address - Fax:617-362-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty