Provider Demographics
NPI:1215944731
Name:AGARD, TANYA O (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:O
Last Name:AGARD
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 1:2354 MID PINE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4603
Mailing Address - Country:US
Mailing Address - Phone:407-383-4042
Mailing Address - Fax:321-207-0175
Practice Address - Street 1:5703 RED BUG LAKE RD # 341
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4969
Practice Address - Country:US
Practice Address - Phone:407-849-7500
Practice Address - Fax:321-207-0175
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG87428Medicare UPIN
43574WMedicare ID - Type Unspecified