Provider Demographics
NPI:1376166884
Name:TUMBLIN, SHANNON D (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:TUMBLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 JACOBS RD
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-9552
Mailing Address - Country:US
Mailing Address - Phone:360-914-0473
Mailing Address - Fax:
Practice Address - Street 1:30 NW BIRCH ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3103
Practice Address - Country:US
Practice Address - Phone:360-678-1515
Practice Address - Fax:360-678-5037
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61073447363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner