Provider Demographics
NPI:1326510827
Name:GADSON, TABITHA LARRINE
Entity Type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:LARRINE
Last Name:GADSON
Suffix:
Gender:F
Credentials:
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 783726
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-3726
Mailing Address - Country:US
Mailing Address - Phone:813-810-8887
Mailing Address - Fax:888-310-3372
Practice Address - Street 1:2008 CURIA RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9812
Practice Address - Country:US
Practice Address - Phone:813-810-8887
Practice Address - Fax:888-310-3372
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 320900000X, 372600000X, 376J00000X, 253Z00000X
FLRN9302004163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker