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Individual
MISTY TATUM
Active
Individual
MISTY TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704431862
MI
363LN0005X
Critical Care Neonatal Nurse Practitioner
163029
TN
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
235107
AR
Other
Enumeration date
03/21/2023
Last updated
04/01/2026
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