Provider Demographics
NPI:1336479922
Name:PAULSON, TABATHA DIANE (APRN-BC/ FNP-C)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:DIANE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:APRN-BC/ FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 CAPSTONE COURT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2795
Mailing Address - Country:US
Mailing Address - Phone:706-327-1281
Mailing Address - Fax:706-327-1159
Practice Address - Street 1:2416 CAPSTONE COURT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2795
Practice Address - Country:US
Practice Address - Phone:706-327-1281
Practice Address - Fax:706-327-1159
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL602-00977OtherBLUE CROSS BLUE SHIELD
AL602-00977OtherBLUE CROSS BLUE SHIELD
AL602-00977OtherBLUE CROSS BLUE SHIELD