Provider Demographics
NPI:1215065248
Name:TASMAN, KAREN GAYLE (ARNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:GAYLE
Last Name:TASMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 DANIEL CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2006
Mailing Address - Country:US
Mailing Address - Phone:239-433-4979
Mailing Address - Fax:239-433-4243
Practice Address - Street 1:6627 DANIEL CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2006
Practice Address - Country:US
Practice Address - Phone:239-433-4979
Practice Address - Fax:239-433-4243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2893362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1856Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER