Tanya R. Bogle, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME122205 Issued in FL

Practice address

17645 Jamestown Way
Lutz, FL 33558-7706

Phone

(423) 718-2698

NPI assigned

Apr 11, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1316380041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17645 JAMESTOWN WAY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335587706",
            "telephone_number": "423-718-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17645 JAMESTOWN WAY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335587706",
            "telephone_number": "423-718-2698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15416 N Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336131244",
            "country_code": "US",
            "telephone_number": "813-960-2400",
            "fax_number": "813-960-2410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOGLE",
        "first_name": "TANYA",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-11",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME122205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019674600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Elizabeth Bobo
• Bhuvan Bodipati
• Gabrielle Bodroghy, IBCLC
• Antony Alexander Boghdadi, DMD
• Samer Boghdady
• Peter R. Bolos, M.D.
• Gitendra Bommareddy, R.PH
• Terra Bone, LCSW
• Loicy Bonet I, BCBA-1-20-42842
• Kimberly Kathlene Booth, M.S., CCC-SLP

• Family Medicine Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.