Provider Demographics
NPI:1982717401
Name:TIOMICO, MARIA GINA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GINA
Last Name:TIOMICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA GINA
Other - Middle Name:DE GUZMAN
Other - Last Name:TIOMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-268-5200
Mailing Address - Fax:
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-268-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250212700Medicaid
FL267954366Medicaid
FL31242VMedicare PIN
FLG30963Medicare UPIN
FL31242YMedicare ID - Type Unspecified