Provider Demographics
NPI:1265025845
Name:TATUM, LINDA L (NP-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:TATUM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:26211 CASA ENCANTADOR RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2913
Mailing Address - Country:US
Mailing Address - Phone:323-573-3137
Mailing Address - Fax:
Practice Address - Street 1:26211 CASA ENCANTADOR RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2913
Practice Address - Country:US
Practice Address - Phone:323-573-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner