Individual
DR. TISHA GALLANTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 244-5044
(904) 244-4508
Mailing address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 982-9586
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
194584
FL
207P00000X
Emergency Medicine Physician
045065
GA
207P00000X
Emergency Medicine Physician
214121-1
NY
207P00000X
Emergency Medicine Physician
Primary
ME79093
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000811885H
—
GA
05
—
00811885I
—
GA
05
—
256861600
—
FL
01
—
49209
BCBS
FL
01
—
930080642
RR CARE
—
01
—
P00242437
RAILROAD MEDICARE
FL
Enumeration date
01/31/2006
Last updated
08/10/2010
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