Provider Demographics
NPI:1578025078
Name:GAMBLE, TANDALEO NMN (APRN)
Entity Type:Individual
Prefix:
First Name:TANDALEO
Middle Name:NMN
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 S HARVARD AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2613
Mailing Address - Country:US
Mailing Address - Phone:918-442-2236
Mailing Address - Fax:918-794-2333
Practice Address - Street 1:4134 S HARVARD AVE STE B3
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2613
Practice Address - Country:US
Practice Address - Phone:918-442-2236
Practice Address - Fax:918-794-2333
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0075294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily