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Individual

MAVANY TANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
32 W GORE ST, ORLANDO, FL 32806-1134
(877) 876-3627
(321) 843-4101
Mailing address
303 E PAR ST, ORLANDO, FL 32804-4003
(877) 876-3627
(321) 843-4101

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA53260
CA
363AM0700X
Medical Physician Assistant
Primary
PA9109290
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
021348500
FL
01
PA53260
CA PA LICENSE
CA
Enumeration date
11/12/2015
Last updated
08/28/2019
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