Individual
DR. TANIS JILL FERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY5946
FL
103TC0700X
Clinical Psychologist
Primary
PY5946
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54467
BLUECROSS/BLUESHIELD
FL
01
—
620006028
RAILROAD MEDICARE
FL
Enumeration date
10/22/2005
Last updated
09/01/2020
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