Provider Demographics
NPI:1376327965
Name:TUMANENG, KARISSA E
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:E
Last Name:TUMANENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1954
Mailing Address - Country:US
Mailing Address - Phone:850-781-8779
Mailing Address - Fax:
Practice Address - Street 1:1804 E LLOYD ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6063
Practice Address - Country:US
Practice Address - Phone:850-781-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician