Provider Demographics
NPI:1326262320
Name:TOMBARKIEWICZ, JOLANTA BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:BARBARA
Last Name:TOMBARKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOLANTA
Other - Middle Name:BARBARA
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6278 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:#389
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:305-606-4659
Mailing Address - Fax:
Practice Address - Street 1:55 N OLD KINGS RD STE E
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5175
Practice Address - Country:US
Practice Address - Phone:386-672-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075433208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0075433OtherLICENSE
FL254566700Medicaid
FL43866ZMedicare ID - Type Unspecified
G76872Medicare UPIN