Provider Demographics
NPI:1487044426
Name:LISA C TUMARKIN, MDPA
Entity Type:Organization
Organization Name:LISA C TUMARKIN, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CINDY
Authorized Official - Last Name:TUMARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-333-5405
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-5405
Mailing Address - Fax:352-333-5407
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 405
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-333-5405
Practice Address - Fax:352-333-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0042098OtherMEDICAL LICENSE
FLME0042098OtherMEDICAL LICENSE