Healthcare Provider Details

I. General information

NPI: 1902340813
Provider Name (Legal Business Name): DIANE TUMOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 STATE RD
DREXEL HILL PA
19026-4605
US

IV. Provider business mailing address

5030 STATE RD
DREXEL HILL PA
19026-4605
US

V. Phone/Fax

Practice location:
  • Phone: 610-394-1330
  • Fax:
Mailing address:
  • Phone: 610-394-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP016622
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0010554
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: