Individual
ANGELA L TATOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
724 W 19TH ST, PANAMA CITY, FL 32405-4101
(850) 769-0278
(850) 769-6202
Mailing address
11945 SAN JOSE BLVD STE 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 396-4893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11007905
FL
363L00000X
Nurse Practitioner
Primary
APRN11007905
FL
Other
Enumeration date
07/24/2020
Last updated
10/13/2020
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