Provider Demographics
NPI:1588759468
Name:JENSEN, TAHIRIH THEONE (DO)
Entity type:Individual
Prefix:DR
First Name:TAHIRIH
Middle Name:THEONE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 PREMIER VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-2885
Mailing Address - Country:US
Mailing Address - Phone:727-366-6165
Mailing Address - Fax:
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3407
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10394207Q00000X
AZ3985207Q00000X
MN107764207Q00000X
FLOS10394207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ882797Medicaid
FL000968100Medicaid
AZ882797001Medicaid
AZ882797Medicaid
FL000968100Medicaid
AZ882797001Medicaid
FLBD257ZMedicare PIN