Provider Demographics
NPI:1225381825
Name:TABB, SHARA NICOLE (CRNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHARA
Middle Name:NICOLE
Last Name:TABB
Suffix:
Gender:F
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4915
Mailing Address - Country:US
Mailing Address - Phone:412-321-4001
Mailing Address - Fax:412-321-4063
Practice Address - Street 1:816 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4915
Practice Address - Country:US
Practice Address - Phone:412-321-4001
Practice Address - Fax:412-321-4063
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN561228363L00000X
PASP012449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102887133Medicaid