Provider Demographics
NPI:1326580184
Name:HART, TABITHA (CNP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:LYNN
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:711 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-2203
Mailing Address - Country:US
Mailing Address - Phone:605-339-0420
Mailing Address - Fax:
Practice Address - Street 1:711 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2203
Practice Address - Country:US
Practice Address - Phone:605-339-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily