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General NPI Number Information
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NPI Number | 1992443501
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Entity Type | Individual
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Provider Name | JESSE TATUM
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 8449 SW STATE RD 200
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City | OCALA
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State | FL
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Zip | 34481
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Country | US
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Telephone | 352-254-2279
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 SW 34TH ST APT 1003
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City | GAINESVILLE
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State | FL
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Zip | 32608-2565
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Country | US
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Telephone |
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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