Provider Demographics
NPI:1851722342
Name:TUMBLESON, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TUMBLESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14044 W CAMELBACK RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9428
Mailing Address - Country:US
Mailing Address - Phone:623-547-2600
Mailing Address - Fax:623-547-1899
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:SUITE 118 AND 216
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-547-2600
Practice Address - Fax:623-547-1899
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010441363LA2100X
AZAP5549363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969817Medicaid