Individual provider Active NPI

Elizabeth Tatum Athans, MD

  • Pediatrics Physician
  • Orlando, FL
National Provider Identifier
1902057417
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME109486 Issued in FL
Practice address
9145 Narcoossee Rd
Suite 103
Orlando, FL 32827-5768
Phone
(407) 243-2040
Fax
(407) 243-2043
NPI assigned
Oct 2, 2008
Last updated
May 26, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME1097486 FL
General Practice Physician 208D00000X ME109486 FL
Pediatrics Physician 208000000X ME109486 FL Primary

Addresses

Primary practice location

9145 Narcoossee Rd
Suite 103
Orlando, FL 32827-5768

Mailing address

P.O. Box 191
Rockland, DE 19732-0191
Phone (302) 651-6212

Other identifiers 1

IdentifierTypeStateIssuer
003539500MedicaidFL

Other names 1

  • Elizabeth Latrelle Tatum Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121022000168 FL Practitioner - Pediatric Medicine 6103076534 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME109486FLMDPediatrics Physician
ME1097486FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Sep 1, 2012 Accepting new patients
The Nemours Foundation Current Accepting new patients
The Nemours Foundation CurrentSince Sep 1, 2012 Accepting new patients

Locations

1371 Citrus Tower Blvd
Clermont, FL 34711
Phone (352) 394-2205

10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

9145 Narcoossee Rd
Ste 103
Orlando, FL 32827
Phone (407) 243-2040

Interoperability endpoints

  • Direct secure messaging: eathans40270@direct.nemours.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432598400000",
    "number": "1902057417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-6212",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9145 NARCOOSSEE RD",
            "address_2": "SUITE 103",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328275768",
            "telephone_number": "407-243-2040",
            "fax_number": "407-243-2043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATHANS",
        "first_name": "ELIZABETH",
        "middle_name": "TATUM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-02",
        "last_updated": "2015-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME1097486",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME109486",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME109486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003539500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "TATUM",
            "middle_name": "LATRELLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.