Individual
JUSTIN JAMES TENNYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5864
(239) 343-2606
(239) 343-3695
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2606
(239) 343-3695
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MT204008
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025088300
—
FL
01
—
MT204008
PA STATE LICENSE
PA
Enumeration date
06/24/2013
Last updated
05/28/2025
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