Provider Demographics
NPI:1780983601
Name:TOMLIN, SHAY N (APN)
Entity type:Individual
Prefix:MRS
First Name:SHAY
Middle Name:N
Last Name:TOMLIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W COMMERCE EXT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1442
Mailing Address - Country:US
Mailing Address - Phone:856-455-5271
Mailing Address - Fax:
Practice Address - Street 1:1070 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4554
Practice Address - Country:US
Practice Address - Phone:856-256-3320
Practice Address - Fax:856-256-3328
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000138363LP0808X
DEL1-0037851163W00000X
NJ26NJ00622500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse