MRS. LICEL TUMPAP (NPI# 1104344969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104344969 |
| Entity Type | Individual |
| Full Name | MRS. LICEL TUMPAP |
| Credential | FNP-C |
| Practice Address |
612 W Baseline Rd Mesa AZ 85210-6041 |
| Mailing Address |
2210 E La Costa Dr Gilbert AZ 85298-9738 |
| Practice Telephone | 4808349039 |
| Practice Fax Number | 4809647802 |
| Mailing Telephone | 4806283066 |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2017-10-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | AP10091 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP10091 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
612 W BASELINE RD |
| City | MESA |
| State | AZ |
| Zip Code | 85210-6041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588692479 | Ijaz Ali | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2006-06-29 |
| 1336686187 | Valley Kidney Corp | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2017-01-31 |
| 1457796179 | Hayun Kim | Registered Nurse | 612 W Baseline Rd, Mesa, AZ 85210 | 2013-05-08 |
| 1831402429 | Roopashree Prabhushankar | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2010-07-23 |
| 1285946707 | Sandra Sue Gaiser | Specialist | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2010-07-13 |
| 1467779413 | Ramya Vejella | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2010-04-30 |
| 1497082432 | Manjunath Shivamanya Kottalgi | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2009-11-12 |
| 1154557866 | Ruchir Sureshbhai Patel | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2009-06-09 |
| 1114175312 | Prashant Kolar | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2008-09-03 |
| 1992981153 | Sridhar G Nair | Internal Medicine | 612 W Baseline Rd, Mesa, AZ 85210-6041 | 2008-01-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053926410 | Matthew Derrick Miller | Nurse Practitioner | 9354 E Thatcher Cir, Mesa, AZ 85212-8539 | 2020-09-12 |
| 1750995858 | Hayley Madler | Nurse Practitioner | 1061 N Omaha Cir, Mesa, AZ 85205-5023 | 2020-09-04 |
| 1043823800 | Nancy Lynn Mitchell | Nurse Practitioner | 1535 N 26th St, Mesa, AZ 85213-4151 | 2020-08-30 |
| 1003429218 | Krista Ann Clevenger | Nurse Practitioner | 3155 E Southern Ave Ste 203, Mesa, AZ 85204-5521 | 2020-08-26 |
| 1093326290 | Joshua Jackson | Nurse Practitioner | 5432 E Southern Ave Ste 101b, Mesa, AZ 85206-2772 | 2020-08-11 |
| 1790395531 | Kelly C Banonis | Nurse Practitioner | 3322 N Brighton, Mesa, AZ 85207-0997 | 2020-08-06 |
| 1689284911 | Katie Keil | Nurse Practitioner | 1061 N Dobson Rd Ste 107, Mesa, AZ 85201-7576 | 2020-08-02 |
| 1831711670 | Saraswati Hamal | Nurse Practitioner | 4850 S Curie Way, Mesa, AZ 85212-9582 | 2020-05-14 |
| 1013539568 | Wingfoot Wellness & Hormones LLC | Nurse Practitioner | 2500 S Power Road, Building 7 Suite 218, Mesa, AZ 85209 | 2020-05-07 |
| 1659992436 | Elizabeth Erb | Nurse Practitioner | 1361 S Alma School Rd, Mesa, AZ 85210-2085 | 2020-05-02 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.