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NPI Code Detail

MEDICARE: MR. COLE JACOB TINKLENBERG INDEPENDENT DUTY HM

MEDICARE: MR. COLE JACOB TINKLENBERG INDEPENDENT DUTY HM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11710I1002XIndependent Duty Corpsman1053039925CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11472480762OTHERVAINDEPENDENT DUTY CORPSMAN

General Provider Information

NPI Number : 1053039925
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COLE JACOB TINKLENBERG INDEPENDENT DUTY HM
Provider Business Mailing Address
First Line : 2189 ELROD AVE BLDG 5003
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2189 ELROD AVE
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5113
Country : US
Telephone Number : 616-284-7607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2022
Last Update Date : 04/20/2026

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