Provider Demographics
NPI:1467685693
Name:TAN-DONAHUE, ANECITA (MD)
Entity type:Individual
Prefix:
First Name:ANECITA
Middle Name:
Last Name:TAN-DONAHUE
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:P.O. BOX 272788
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2788
Mailing Address - Country:US
Mailing Address - Phone:813-931-0400
Mailing Address - Fax:813-931-0300
Practice Address - Street 1:13610 SOUTH VILLAGE DRIVE
Practice Address - Street 2:UNIT #312
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-767-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068788208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001658400Medicaid
FL27543OtherBLUE CROSS PROV #
FLG15390Medicare UPIN