Provider Demographics
NPI:1881834562
Name:TATE, WINIFRED EILEEN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:WINIFRED
Middle Name:EILEEN
Last Name:TATE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:WIN
Other - Middle Name:EILEEN
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:836 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8334
Mailing Address - Country:US
Mailing Address - Phone:904-388-6518
Mailing Address - Fax:904-384-1005
Practice Address - Street 1:836 PRUDENTIAL DRIVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:JACKSONVILLE
Practice Address - State:FLORIDA
Practice Address - Zip Code:32207
Practice Address - Country:UM
Practice Address - Phone:904-388-6518
Practice Address - Fax:904-384-1005
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2086602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner