Provider Demographics
NPI:1619200367
Name:TUMALAD, JOE D (NP)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:D
Last Name:TUMALAD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1204 MECHEM DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7207
Mailing Address - Country:US
Mailing Address - Phone:575-808-8297
Mailing Address - Fax:575-449-2623
Practice Address - Street 1:1204 MECHEM DR STE 1
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7207
Practice Address - Country:US
Practice Address - Phone:281-444-1711
Practice Address - Fax:281-456-3437
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX564554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner