Individual
MRS. JACQUELINE JULIET TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NON PAR PROVIDER
Contact information
Practice address
2600 HINGHAM LN, COLUMBUS, OH 43224-3725
(614) 800-9748
(614) 934-5732
Mailing address
2600 HINGHAM LN, COLUMBUS, OH 43224-3725
(614) 800-9745
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053979
—
OH
01
—
1982989679
WAIVER PROVIDER
OH
Enumeration date
10/13/2011
Last updated
11/08/2022
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