Provider Demographics
NPI:1164670634
Name:TUNNELL, ISAAC B (PA)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:B
Last Name:TUNNELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6702
Mailing Address - Country:US
Mailing Address - Phone:702-948-8660
Mailing Address - Fax:702-483-6663
Practice Address - Street 1:6120 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6702
Practice Address - Country:US
Practice Address - Phone:702-948-8660
Practice Address - Fax:702-483-6663
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC0160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164670634Medicaid