Provider Demographics
NPI:1275964223
Name:TUMBAGA, BEVERLY ESPLANA (APRN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ESPLANA
Last Name:TUMBAGA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:ESPLANA
Other - Last Name:MANGAYAYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0669
Mailing Address - Country:US
Mailing Address - Phone:808-338-8311
Mailing Address - Fax:808-338-0225
Practice Address - Street 1:4643 WAIMEA CANYON DR.
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:180-833-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRX-503363LF0000X
HIAPRN-1537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily