Provider Demographics
NPI:1710205539
Name:REIMSCHISSEL, TANYA MARIE (DO)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:REIMSCHISSEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 W 8TH ST # L18
Mailing Address - Street 2:LRC 4TH FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-383-1003
Mailing Address - Fax:904-244-7388
Practice Address - Street 1:655 W 8TH ST FL ST1
Practice Address - Street 2:1ST FL, PRIMARY CARE CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1003
Practice Address - Fax:904-244-7388
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 2338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine