Individual
JULIE TAN ANTIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6472
(731) 541-3188
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6472
(731) 541-3188
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
38425
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3326081
—
TN
05
—
3326089
—
TN
01
—
4097479
BCBS
—
01
—
P00179539
RR MEDICARE
—
01
—
P00181736
RR MEDICARE
TN
Enumeration date
07/18/2006
Last updated
02/10/2010
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