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NPI Code Detail

MEDICARE: JAMILAH MALIKAH TULLOCH PMHNP

MEDICARE: JAMILAH MALIKAH TULLOCH PMHNP
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
1163W00000XRegistered NurseRN9567103FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11038357FL

General Provider Information

NPI Number : 1568274785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMILAH MALIKAH TULLOCH PMHNP
Provider Business Mailing Address
First Line : 200 E ROBINSON ST STE 425
Second Line :
City : ORLANDO
State : FL
Zip : 32801-4347
Country : US
Telephone Number : 833-769-3524
Fax Number : 407-583-4988
Provider Business Practice Location Address
First Line : 200 E ROBINSON ST STE 425
Second Line :
City : ORLANDO
State : FL
Zip : 32801-4347
Country : US
Telephone Number : 833-769-3524
Fax Number : 407-583-4988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2025
Last Update Date : 10/24/2025

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