Active NPI
Maggie Tzivanis
- Pharmacist
- Port St Lucie, FL
National Provider Identifier
1245850379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS58128
- Practice address
- 1954 SW Gatlin Blvd
Port St Lucie, FL 34953-2722 - Phone
- (772) 224-3020
- NPI assigned
- Apr 18, 2020
- Last updated
- Apr 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS58128 | FL | Primary |
Addresses
Primary practice location
1954 SW Gatlin Blvd
Port St Lucie, FL 34953-2722
Mailing address
4424 Main St Apt 4055
Jupiter, FL 33458-5360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS58128 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1954 SW Gatlin Blvd
Port St Lucie, FL 34953
Phone (772) 224-3020
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587168000000",
"number": "1245850379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4424 MAIN ST APT 4055",
"city": "JUPITER",
"state": "FL",
"postal_code": "334585360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1954 SW GATLIN BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349532722",
"telephone_number": "772-224-3020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TZIVANIS",
"first_name": "MAGGIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-18",
"last_updated": "2020-04-18",
"certification_date": "2020-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS58128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.