Provider Demographics
NPI:1891121349
Name:TATIC, ARNELA (NP)
Entity Type:Individual
Prefix:
First Name:ARNELA
Middle Name:
Last Name:TATIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ARNELA
Other - Middle Name:
Other - Last Name:TATIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0566
Mailing Address - Country:US
Mailing Address - Phone:210-780-7788
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:10151 DEERWOOD PARK BLVD STE 310
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0566
Practice Address - Country:US
Practice Address - Phone:772-581-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB853BMedicare PIN