Provider Demographics
NPI:1649523408
Name:TOMLINSON, THERESA L (CRNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:L
Other - Last Name:KOHLBUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7315
Mailing Address - Fax:717-741-3056
Practice Address - Street 1:924 COLONIAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3450
Practice Address - Country:US
Practice Address - Phone:717-851-7315
Practice Address - Fax:717-843-6682
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012446363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1617427OtherGATEWAY MEDICARE ASSURED
PA2793595OtherHIGHMARK BLUE SHIELD FREEDOM BLUE
PA1617427OtherGATEWAY MEDICARE ASSURED
PA263711FLTMedicare PIN