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Jordan Licata
Student in an Organized Health Care Education/Training Program in Tullahoma, Tennessee
NPI 1952795106

Jordan Licata is a Student in an Organized Health Care Education/Training Program based in Tullahoma, TN. Jordan Licata practices in Tullahoma, TN. The NPI Number for Jordan Licata is 1952795106 and holds a License No. (Tennessee).

The current practice location address for Jordan Licata is 1821 N Washington St, Tullahoma, TN and can be reached out via phone at 931-461-5056 and via fax at 931-455-4450.

Location: 1821 N Washington St, Tullahoma, TN, 37388-2221
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1952795106
Provider Name
Jordan Licata
Credential
Provider Entity Type
Individual
Gender
Male
Address
1821 N Washington St, Tullahoma, TN, 37388-2221
Phone Number
931-461-5056
Fax Number
931-455-4450
Provider Enumeration Date
03/26/2015
Last Update Date
12/14/2024
institution
Provider Business Practice Location Address Details
Address
1821 N Washington St
City
Tullahoma
State
Tennessee
Zip
37388-2221
Phone Number
931-461-5056
Fax Number
931-455-4450
person
Provider Business Mailing Address Details
Address
1821 N Washington St
City
Tullahoma
State
Tennessee
Zip
37388-2221
Phone Number
931-461-5056
Fax Number
931-455-4450
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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