Provider Demographics
NPI:1043073687
Name:TIBBITTS, TRISHA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:TIBBITTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2726
Mailing Address - Country:US
Mailing Address - Phone:641-481-8711
Mailing Address - Fax:
Practice Address - Street 1:1631 4TH ST SW # 114B
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1612
Practice Address - Country:US
Practice Address - Phone:641-243-4593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA177956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily