Provider Demographics
NPI:1093782575
Name:JATI, ANUBHA (MD)
Entity Type:Individual
Prefix:
First Name:ANUBHA
Middle Name:
Last Name:JATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16036 THORN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4133
Mailing Address - Country:US
Mailing Address - Phone:803-641-5000
Mailing Address - Fax:
Practice Address - Street 1:302 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6302
Practice Address - Country:US
Practice Address - Phone:803-641-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC401642084N0400X
LAMD.15268R2084N0400X
MS15268R204D00000X
FLME1213562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015253500Medicaid
SCPENDINGMedicaid
MS01457513Medicaid
LA1196096Medicaid
MS302I131383Medicare PIN
FL015253500Medicaid
103055Medicare UPIN
LA366193YH3VMedicare PIN
SCPENDINGMedicaid
LA4F733Medicare PIN