Provider Demographics
NPI:1568274785
Name:TULLOCH, JAMILAH MALIKAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMILAH
Middle Name:MALIKAH
Last Name:TULLOCH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 PROVIDENCE BLVD STE R#1142
Mailing Address - Street 2:STE R#1142
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725
Mailing Address - Country:US
Mailing Address - Phone:407-492-4917
Mailing Address - Fax:
Practice Address - Street 1:1235 PROVIDENCE BLVD STE R#1142
Practice Address - Street 2:STE R#1142
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:407-492-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9567103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse