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General NPI Number Information
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NPI Number | 1104267871
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Entity Type | Individual
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Provider Name | JESSICA R TATE MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 15 DANIEL DR
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City | GULF BREEZE
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State | FL
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Zip | 32561-4418
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Country | US
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Telephone | 850-746-0280
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Fax | 850-746-0281
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Provider Business Mailing Address
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Address Line | 15 DANIEL DR FL 1
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City | GULF BREEZE
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State | FL
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Zip | 32561-4418
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Country | US
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Telephone | 850-746-0280
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Fax | 850-764-0281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME129054
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License Number State | FL
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