Provider Demographics
NPI:1104267871
Name:TATE, JESSICA R (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:TATE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 DANIEL DR FL 1
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4418
Mailing Address - Country:US
Mailing Address - Phone:850-746-0280
Mailing Address - Fax:850-764-0281
Practice Address - Street 1:15 DANIEL DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4418
Practice Address - Country:US
Practice Address - Phone:850-746-0280
Practice Address - Fax:850-746-0281
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME129054208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics