Individual
MRS. CAROL TANNER-ST. JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1890 LPGA BLVD, 170, DAYTONA BEACH, FL 32117-7130
(386) 274-3354
(386) 274-5564
Mailing address
1890 LPGA BLVD, 170, DAYTONA BEACH, FL 32117-7130
(386) 274-3354
(386) 274-5564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0047427
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04160
BLUE CROSS BLUE SHIELD
FL
01
—
ME0047427
STATE LICENSE NUMBER
FL
Enumeration date
10/11/2007
Last updated
04/13/2011
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