Provider Demographics
NPI:1417576463
Name:TABI, ANNIE E (PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:E
Last Name:TABI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:ANNIE
Other - Middle Name:E
Other - Last Name:OGUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:292 SAINT MICHAELS CIR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1086
Mailing Address - Country:US
Mailing Address - Phone:240-413-8399
Mailing Address - Fax:
Practice Address - Street 1:2528 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7203
Practice Address - Country:US
Practice Address - Phone:443-548-3733
Practice Address - Fax:410-360-1675
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191166363LF0000X
MD20221161319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD542025300Medicaid