Jordan Licata, DO

NPI #1952795106 in Tullahoma, Tennessee

Provider Information

NPI Number: 1952795106
Entity Type: Individual
Name: Jordan Licata, DO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Otolaryngology
Credential: DO
Enumeration Date: Mar 26, 2015
Last Updated: Dec 12, 2024

Practice Location

Address: 1821 N WASHINGTON ST
City: Tullahoma
State: Tennessee
ZIP Code: 37388-2221
Phone: (931) 461-5056

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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