Healthcare Provider Details

I. General information

NPI: 1518481084
Provider Name (Legal Business Name): TATUM ERIN NOLAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 N FEDERAL HWY
FORT LAUDERDALE FL
33308-5206
US

IV. Provider business mailing address

860 NW 115TH AVE
PLANTATION FL
33325-1500
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-0582
  • Fax:
Mailing address:
  • Phone: 954-801-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: