Healthcare Provider Details

I. General information

NPI: 1366625402
Provider Name (Legal Business Name): SHAREE L TUMBLING RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY STE 500
BOCA RATON FL
33487-2791
US

IV. Provider business mailing address

1010 GLENRIDGE STRATFORD DR NE
ATLANTA GA
30342-4909
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone: 678-525-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number27011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: