Mary Ann Tesalona, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0063400 Issued in FL

Practice address

2146 Vindale Rd
Tavares, FL 32778-5602

Phone

(352) 742-1715

NPI assigned

Jul 18, 2005

Last updated

Jan 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1396744967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2146 VINDALE RD",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785602",
            "telephone_number": "352-742-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2146 VINDALE RD",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785602",
            "telephone_number": "352-742-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESALONA",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0063400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371959600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "18442",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tavares Surgery LLC
• Tavares Village Retirement Community, LLC (The Cove at Tavares Village)
• Kayli Taylor, ARNP
• Ramona Teasley, M.S., CCC-SLP
• Shelby L Terpstra, D.O.
• The Gardens at Tavares
• The Grove Pediatric Therapy LLC
• The Heritage of Tavares Alf
• Devon Nicole Thomas, MD
• Khannia Erif Thomas, MD

• Family Medicine Physician in Tavares, FL
• Providers in Tavares, 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 Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.