Provider Demographics
NPI:1942053467
Name:TAN PEREDA, ZOE (MD)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:TAN PEREDA
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 1:10661 JACATREE CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7345
Mailing Address - Country:US
Mailing Address - Phone:239-202-3941
Mailing Address - Fax:
Practice Address - Street 1:2400 HARBOR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5038
Practice Address - Country:US
Practice Address - Phone:941-629-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1737208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice