Healthcare Provider Details

I. General information

NPI: 1992015994
Provider Name (Legal Business Name): TAMARA BUMPUS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2010
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 JEFFERSON AVE
TOLEDO OH
43604-1004
US

IV. Provider business mailing address

313 JEFFERSON AVE
TOLEDO OH
43604-1004
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-7883
  • Fax: 419-255-6438
Mailing address:
  • Phone: 419-255-7883
  • Fax: 419-255-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11785-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: