Provider Demographics
NPI:1013753839
Name:JATTAN, DOROTHEA MYLES (PMHNP)
Entity type:Individual
Prefix:MS
First Name:DOROTHEA
Middle Name:MYLES
Last Name:JATTAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 WATER OAK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7535
Mailing Address - Country:US
Mailing Address - Phone:305-978-4309
Mailing Address - Fax:
Practice Address - Street 1:4510 WATER OAK LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7535
Practice Address - Country:US
Practice Address - Phone:305-978-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health