Provider Demographics
NPI:1457446346
Name:TIBBS, HEATHER S (PAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:TIBBS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:S
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:100 MCGREGOR STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-669-0413
Mailing Address - Fax:603-663-6111
Practice Address - Street 1:100 MCGREGOR STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-669-0413
Practice Address - Fax:603-663-6111
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0602P363A00000X
NH0602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30334606Medicaid
NHAP2724Medicare PIN
NH30334606Medicaid