Individual
BRIAN TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6905 HERITAGE DR, PORT ST LUCIE, FL 34952-8227
(772) 370-5547
Mailing address
4230 SW CALLICOE ST, PORT SAINT LUCIE, FL 34953-3189
(772) 370-5547
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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