Provider Demographics
NPI:1306409487
Name:MERRITT, TABITHA DENISE (NP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:DENISE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-7257
Mailing Address - Fax:864-654-7672
Practice Address - Street 1:895 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1480
Practice Address - Country:US
Practice Address - Phone:864-512-7257
Practice Address - Fax:864-654-7672
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily