Individual
DR. JOSEPHINE RACIMO ESTAMPADOR TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1125 N CENTRAL AVE, KISSIMMEE, FL 34741-4405
(407) 931-1887
(407) 931-2056
Mailing address
1125 N CENTRAL AVE, KISSIMMEE, FL 34741-4405
(407) 931-1887
(407) 931-2056
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME 60270
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1290808
CIGNA PROVIDER ID #
FL
01
—
14049
BCBS PROVIDER ID #
FL
01
—
173108
WELLCARE PROVIDER ID #
FL
01
—
270637
AVMED PROVIDER ID #
FL
05
—
371692900
—
FL
Enumeration date
11/02/2005
Last updated
11/26/2012
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