Provider Demographics
NPI:1033858774
Name:SAULMON, TESA NASHAA
Entity Type:Individual
Prefix:
First Name:TESA
Middle Name:NASHAA
Last Name:SAULMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 WINTERPINE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6806
Mailing Address - Country:US
Mailing Address - Phone:559-471-9249
Mailing Address - Fax:
Practice Address - Street 1:3995 HUNT CLUB RD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-8416
Practice Address - Country:US
Practice Address - Phone:904-735-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health