Provider Demographics
NPI:1003276924
Name:BAUGHMAN, TABITHA MARRIE (NP-C)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:MARRIE
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BIRCH ST
Mailing Address - Street 2:C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-4158
Mailing Address - Country:US
Mailing Address - Phone:740-501-4705
Mailing Address - Fax:
Practice Address - Street 1:180 BIRCH ST
Practice Address - Street 2:C
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4158
Practice Address - Country:US
Practice Address - Phone:740-501-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1215334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily