Individual
TINA JEAN BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP C
Contact information
Practice address
75 EMERSON BAY RD STE 102, CAROLINA SHORES, NC 28467-2498
(910) 579-8363
(910) 579-8306
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 579-8363
(910) 579-8306
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5003968
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7902054
—
NC
01
—
NCF599B
MEDICARE PTAN
NC
Enumeration date
05/08/2008
Last updated
05/05/2025
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