Individual
ABIGAIL ELIZABETH TATTERSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
16271 BASS RD, FORT MYERS, FL 33908-3616
(239) 343-7100
(239) 343-7190
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-7100
(239) 343-7190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0836
NH
363A00000X
Physician Assistant
Primary
PA9110197
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115205600
—
FL
Enumeration date
10/24/2006
Last updated
09/01/2022
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