Provider Demographics
NPI:1295197366
Name:TUITT, JEROME JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:JOEL
Last Name:TUITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HEALTH PARK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5784
Mailing Address - Country:US
Mailing Address - Phone:904-819-4085
Mailing Address - Fax:904-819-5156
Practice Address - Street 1:400 HEALTH PARK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-819-4085
Practice Address - Fax:904-819-5056
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC1218207R00000X, 208M00000X
MEMD26651208M00000X
390200000X
FLME139998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program