Marnelli Deborah Geronimo Tan

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN32087 Issued in FL

Practice address

13127 Kings Lake Dr Unit 101
Gibsonton, FL 33534-3958

Phone

(813) 677-3047

NPI assigned

Jun 25, 2026

Last updated

Jun 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Kidzone Dentistry PA

  • Pediatric Dentistry
  • Gibsonton, FL
  • NPI 1134531270
  NPD (past)

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

{
    "created_epoch": "1782345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1457277386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 CARRIAGE CROSSING CIR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335102178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13127 KINGS LAKE DR UNIT 101",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343958",
            "telephone_number": "813-677-3047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "MARNELLI",
        "middle_name": "DEBORAH GERONIMO",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-06-25",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN32087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leira Marie Santana, ARNP
• Genquetta Michelle Smith, INDEPENDE CONTRACTOR
• Southshore Orthodontics PA
• Southshore Pharmacy, Inc.
• Lily Katherine Szwejbka, PT, DPT
• Thai Pham DMD PA (Endodontic Innovations)
• Raquel Threatts
• Tykeila Ieshia Tisdale, CMHC, RMHC-I
• Martha Isabel Turell
• Unconditional Care LLC

• General Practice Dentistry in Gibsonton, FL
• Providers in Gibsonton, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; 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.