Provider Demographics
NPI:1649707621
Name:ZANGANEH, TATIANA (MD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:ZANGANEH
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-8880
Mailing Address - Fax:239-343-4213
Practice Address - Street 1:11390 SUMMERLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-5300
Practice Address - Country:US
Practice Address - Phone:239-343-8880
Practice Address - Fax:239-343-4213
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473186207WX0110X
VA0101265404207WX0110X, 208D00000X
FLME163313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120722200Medicaid