Provider Demographics
NPI:1447675988
Name:TATUM, NICOLETA M (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLETA
Middle Name:M
Last Name:TATUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N RICHARD JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2562
Mailing Address - Country:US
Mailing Address - Phone:850-636-7000
Mailing Address - Fax:850-636-7072
Practice Address - Street 1:140 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:850-636-7072
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9293091363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health