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General NPI Number Information
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NPI Number | 1356292353
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Entity Type | Individual
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Provider Name | NICOLETTE DELORES TOMBLYN RN
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Gender | Female
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 420 S GERMANTOWN PKWY
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City | CORDOVA
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State | TN
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Zip | 38018-4387
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Country | US
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Telephone | 901-651-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 1297 BELFAIR DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1437
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Country | US
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Telephone | 901-651-1747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 279197
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License Number State | TN
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