Look up the most recent NPI and PECOS records

Mary E Tatum

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

PECOS Enrollment

This provider is enrolled in PECOS as MARY TATUM.

Based on the most recent information from CMS, provider Mary E Tatum is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 1:10 PM.

Profile Details

Provider ID
1013253871
Provider Type
Individual
Full Name
Tatum, Mary E
Title
Ms.
Credential
N.P.

Gender
Female
Sole Proprietor
No
Enumeration Date
12/26/2012
Last Updated
9/2/2020

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License APRN11005295 Florida
Code 363LC0200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5007226 North Carolina

Mary E Tatum

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Ryland, Kristen

Leybag, Angelica Joyce Fernandez

Bezerra, Andre Luiz

Thornton, Lucy Holly

Brown, Alethea Brooke

Pelkowski, Jessica

Akin, Catherine Raney

Esomonu, Chinenye

Waugh, Kristen

Weinert, Danielle Suzanne