Provider Demographics
NPI:1447261722
Name:TUMBLIN, SHERYL L (CNP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:L
Last Name:TUMBLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W HIGH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4300
Mailing Address - Country:US
Mailing Address - Phone:419-998-4573
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:3123 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2516
Practice Address - Country:US
Practice Address - Phone:419-222-8811
Practice Address - Fax:419-227-2806
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00326009OtherRAILROAD MEDICARE
OH2290846Medicaid
OHNP05636Medicare PIN