Provider Demographics
NPI:1720494503
Name:TUMULAK, CELSO E JR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CELSO
Middle Name:E
Last Name:TUMULAK
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6112
Mailing Address - Country:US
Mailing Address - Phone:956-686-2700
Mailing Address - Fax:
Practice Address - Street 1:801 E NOLANA AVE STE 13
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-686-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125775363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387104YLPSOtherWELLMED PTAN