Healthcare Provider Details

I. General information

NPI: 1801393400
Provider Name (Legal Business Name): TAO WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

653-1 W 8TH ST
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1004
  • Fax:
Mailing address:
  • Phone: 904-383-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME165298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: