Provider Demographics
NPI:1033636535
Name:COPELAND, TABITHA (MSN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 FORREST LN
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8196
Mailing Address - Country:US
Mailing Address - Phone:706-718-9993
Mailing Address - Fax:
Practice Address - Street 1:1405 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-9170
Practice Address - Country:US
Practice Address - Phone:910-277-2440
Practice Address - Fax:910-277-2450
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC298857363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health