Provider Demographics
NPI:1518283993
Name:TUMKUR, AMBICA MANJUNATH (MD)
Entity Type:Individual
Prefix:
First Name:AMBICA
Middle Name:MANJUNATH
Last Name:TUMKUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIRCLE
Practice Address - Street 2:USF SOUTH TAMPA OFFICE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33601
Practice Address - Country:US
Practice Address - Phone:813-259-8577
Practice Address - Fax:813-259-8551
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1235812084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150NEOtherBLUE CROSS BLUE SHIELD
FL015381600Medicaid
FL150NEOtherBLUE CROSS BLUE SHIELD
FLIH050ZMedicare PIN