Provider Demographics
NPI:1053039925
Name:TINKLENBERG, COLE JACOB (INDEPENDENT DUTY HM)
Entity type:Individual
Prefix:MR
First Name:COLE
Middle Name:JACOB
Last Name:TINKLENBERG
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34101 FARENHOLT AVE BLDG 14
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-7000
Mailing Address - Country:US
Mailing Address - Phone:616-284-7607
Mailing Address - Fax:
Practice Address - Street 1:1530 GILBERT ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2730
Practice Address - Country:US
Practice Address - Phone:616-284-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10530399251710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1472480762OtherINDEPENDENT DUTY CORPSMAN