Provider Demographics
NPI:1114438199
Name:MIZE, TABATHA KRISTI (FNP-C)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:KRISTI
Last Name:MIZE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HARLEY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8812
Mailing Address - Country:US
Mailing Address - Phone:936-672-2961
Mailing Address - Fax:936-672-2961
Practice Address - Street 1:17400 ST LUKES WAY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8036
Practice Address - Country:US
Practice Address - Phone:936-266-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135492363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily