Healthcare Provider Details

I. General information

NPI: 1285248286
Provider Name (Legal Business Name): DR JESSICA TAUB PODIATRY DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

IV. Provider business mailing address

3515 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-3800
  • Fax: 772-283-7046
Mailing address:
  • Phone: 772-283-3800
  • Fax: 772-283-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA TAUB
Title or Position: OWNER PROVIDER
Credential: DPM
Phone: 772-283-3800