Healthcare Provider Details

I. General information

NPI: 1831478346
Provider Name (Legal Business Name): TARA ELIZABETH TUMULTY C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105
US

IV. Provider business mailing address

1519 OAK AVE NE
OLYMPIA WA
98506-4323
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2599
  • Fax: 206-729-3070
Mailing address:
  • Phone: 617-877-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberN360240214
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: