Provider Demographics
NPI:1902617608
Name:TANHEALTH WELLNESS PAIN AND SPINE CENTER
Entity type:Organization
Organization Name:TANHEALTH WELLNESS PAIN AND SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOVANIE SERGE
Authorized Official - Middle Name:KEUSSEU
Authorized Official - Last Name:TANKEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-292-0515
Mailing Address - Street 1:14131 METROPOLIS AVENUE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:757-292-0515
Mailing Address - Fax:239-561-0090
Practice Address - Street 1:14131 METROPOLIS AVENUE SUITE 106
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:757-292-0515
Practice Address - Fax:239-561-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty