Provider Demographics
NPI:1598725194
Name:TUMARKIN, LISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:TUMARKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0042098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0360741-00Medicaid
FLME0042098OtherSTATE LICENSE
FLME0042098OtherSTATE LICENSE