Brian Tatum
Clinic/Center, Developmental Disabilities in Port St Lucie, FL. Individual provider (NPI-1).
NPI number1669984167
StatusActive
Last updated in NPPESOct 25, 2017
Details
- NPI
- 1669984167
- Entity type
- Individual (NPI-1)
- Name
- Brian Tatum
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 25, 2017
- Last updated
- Oct 25, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD1600X | Clinic/Center, Developmental Disabilities | – | – | Yes |
Practice location
6905 Heritage DrPort St Lucie, FL 34952-8227
Phone 772-370-5547
Mailing address
4230 Sw Callicoe StPort Saint Lucie, FL 34953-3189
Phone 772-370-5547
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All 16 Developmental Disabilities Clinic/Center providers in Port St Lucie · All 3,747 providers in Port St Lucie
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