Individual
STACI L TANOUYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1361 13TH AVE S STE &110&115, JACKSONVILLE BEACH, FL 32250-3233
(904) 247-5514
(904) 247-3363
Mailing address
PO BOX 748817, ATLANTA, GA 30374-8817
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
52096
MN
207V00000X
Obstetrics & Gynecology Physician
Primary
ME117299
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010025600
—
FL
Enumeration date
07/29/2008
Last updated
06/22/2023
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