Provider Demographics
NPI:1053796342
Name:JELIC, TOMISLAV (MD)
Entity type:Individual
Prefix:DR
First Name:TOMISLAV
Middle Name:
Last Name:JELIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE DAVIS BLVD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:813-990-9469
Mailing Address - Fax:
Practice Address - Street 1:ONE DAVIS BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-627-5973
Practice Address - Fax:813-254-6440
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine