Individual
SHAVON TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP-C
Contact information
Practice address
1632 PINE ST, PHILADELPHIA, PA 19103-6711
(215) 735-7922
Mailing address
570 N 5TH ST APT 534, PHILADELPHIA, PA 19123-3699
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NJ14974500
NJ
363L00000X
Nurse Practitioner
Primary
SP029198
PA
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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