Provider Demographics
NPI:1972197937
Name:TINGLAN, JESSICA LYNN (CNM, CLS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:TINGLAN
Suffix:
Gender:F
Credentials:CNM, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744-9780
Mailing Address - Country:US
Mailing Address - Phone:989-798-5789
Mailing Address - Fax:
Practice Address - Street 1:4132 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-9780
Practice Address - Country:US
Practice Address - Phone:989-798-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife