Provider Demographics
NPI:1548372923
Name:TOMPKINS, JODIE L (NP)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:L
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:22 W COLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9431
Mailing Address - Country:US
Mailing Address - Phone:207-780-6565
Mailing Address - Fax:207-878-6565
Practice Address - Street 1:1321 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3675
Practice Address - Country:US
Practice Address - Phone:207-780-6565
Practice Address - Fax:207-878-6565
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MER049271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432341199Medicaid
Q77026Medicare UPIN
NP5654Medicare PIN