Healthcare Provider Details

I. General information

NPI: 1326262320
Provider Name (Legal Business Name): JOLANTA BARBARA TOMBARKIEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOLANTA BARBARA PERRY

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N OLD KINGS RD STE E
ORMOND BEACH FL
32174-5175
US

IV. Provider business mailing address

6278 NORTH FEDERAL HIGHWAY #389
FORT LAUDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-4615
  • Fax:
Mailing address:
  • Phone: 305-606-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0075433
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0075433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: