Individual
SUZANA TANIMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
77 8TH ST S STE B, NAPLES, FL 34102-6111
(239) 325-2015
Mailing address
77 8TH ST S STE B, NAPLES, FL 34102-6111
(239) 325-2015
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PA9111967
FL
207W00000X
Ophthalmology Physician
Primary
PA9111967
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9111967
FLORIDA MEDICAL LICENSE
FL
Enumeration date
03/04/2019
Last updated
03/04/2019
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