Provider Demographics
NPI:1770890147
Name:TARDY-RIVERA, FRANCES GLORIE (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:GLORIE
Last Name:TARDY-RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100374
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0374
Mailing Address - Country:US
Mailing Address - Phone:352-265-0291
Mailing Address - Fax:352-265-0279
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3001
Practice Address - Country:US
Practice Address - Phone:352-265-0291
Practice Address - Fax:352-265-0279
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12622-I208D00000X
FLME1285632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017865100Medicaid
FLIQ841ZMedicare PIN