MEDICARE: TESA NASHAA SAULMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH22565	FL

General Provider Information

NPI Number	:	1033858774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESA NASHAA SAULMON

Provider Business Mailing Address
First Line	:	12309 WINTERPINE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6806
Country	:	US
Telephone Number	:	559-471-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 HUNT CLUB RD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-8416
Country	:	US
Telephone Number	:	904-735-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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