Provider Demographics
NPI:1093458911
Name:LABITAN, MA THEA HEIDI (RN)
Entity Type:Individual
Prefix:
First Name:MA THEA HEIDI
Middle Name:
Last Name:LABITAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 OLD HICKORY BLVD APT 1303
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3768
Mailing Address - Country:US
Mailing Address - Phone:904-314-7937
Mailing Address - Fax:
Practice Address - Street 1:2828 OLD HICKORY BLVD APT 1303
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-3768
Practice Address - Country:US
Practice Address - Phone:904-314-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN244995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse