Provider Demographics
NPI:1952897423
Name:TABLADA, DERLYN TUMAKAY (FNP)
Entity Type:Individual
Prefix:MS
First Name:DERLYN
Middle Name:TUMAKAY
Last Name:TABLADA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DERLYN
Other - Middle Name:B
Other - Last Name:TUMAKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2160 APPIAN WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2565
Mailing Address - Country:US
Mailing Address - Phone:510-724-9110
Mailing Address - Fax:
Practice Address - Street 1:2160 APPIAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2565
Practice Address - Country:US
Practice Address - Phone:510-724-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008061363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner