Individual
DR. JOSEPH E TIENSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
63 BARKLEY CIR, STE. 100 & 101, FORT MYERS, FL 33907-4514
(239) 938-3500
(239) 278-0055
Mailing address
8791 CONFERENCE DR, SUITE 1, FORT MYERS, FL 33919-5822
(239) 938-3506
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME0045066
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004093006
AETNA
—
01
—
205472
AMERIGROUP
—
01
—
300064841
RR MEDICARE
FL
01
—
36420
BCBSFL
—
01
—
ME45066
FL WC CERTIFICATION
—
05
—
O36234400
—
FL
Enumeration date
05/27/2006
Last updated
04/09/2014
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