Provider Demographics
NPI:1386045862
Name:AMMANN, TABITHA MARIE (DNP, CNP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:MARIE
Last Name:AMMANN
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6030
Mailing Address - Country:US
Mailing Address - Phone:605-504-1900
Mailing Address - Fax:605-504-1901
Practice Address - Street 1:6100 S LOUISE AVE STE 1110
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6030
Practice Address - Country:US
Practice Address - Phone:605-504-1900
Practice Address - Fax:605-504-1901
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily