Provider Demographics
NPI:1841608775
Name:TUMBLESON, CATHERINE ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:TUMBLESON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5127
Mailing Address - Country:US
Mailing Address - Phone:843-839-7246
Mailing Address - Fax:
Practice Address - Street 1:4731 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5127
Practice Address - Country:US
Practice Address - Phone:843-839-7246
Practice Address - Fax:843-839-7323
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2104363A00000X
NC0010-05646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant