Provider Demographics
NPI:1285869610
Name:TANZLER, EMILY DURRETT (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DURRETT
Last Name:TANZLER
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 1:7015 A C SKINNER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:7015 A C SKINNER PKWY
Practice Address - Street 2:BUILDING 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6932
Practice Address - Country:US
Practice Address - Phone:904-363-2113
Practice Address - Fax:904-363-2606
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13797207R00000X
FLME1191322085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4847422OtherAETNA
FL14VS9OtherBCBS
FL374163OtherAVMED
FL012055700Medicaid
FL14VS9OtherBCBS