Healthcare Provider Details

I. General information

NPI: 1659843019
Provider Name (Legal Business Name): JOSELITO TARUC DE LEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 W BASE ST
MADISON FL
32340-2064
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-1402
  • Fax: 850-973-1450
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: