JORDAN LICATA

TULLAHOMA, TN
NPI1952795106
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Y00000X Otolaryngology
(Licence: TN  5294)
Additional Taxonomies207Y00000X Otolaryngology
(Licence: KY  05799)
Enumeration Date2015-03-26
Last Update Date2024-12-12
Business Address
JORDAN LICATA DO
1821 N WASHINGTON ST
TULLAHOMA, TN 37388-2221
Phone number: 931-461-5056
Mailing Address
JORDAN LICATA DO
1821 N WASHINGTON ST
TULLAHOMA, TN 37388-2221
Phone number: 931-461-5056