Provider Demographics
NPI:1003493073
Name:TABBA, JUDE
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:
Last Name:TABBA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N FEDERAL HWY STE 601
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2467
Mailing Address - Country:US
Mailing Address - Phone:954-482-4747
Mailing Address - Fax:954-301-5939
Practice Address - Street 1:701 N FEDERAL HWY STE 601
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2467
Practice Address - Country:US
Practice Address - Phone:954-482-4747
Practice Address - Fax:954-301-5939
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program