Provider Demographics
NPI:1467232827
Name:WHITE, TABITHA TERRELL
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:TERRELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5088
Mailing Address - Country:US
Mailing Address - Phone:786-487-7344
Mailing Address - Fax:
Practice Address - Street 1:2101 S PALM AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5088
Practice Address - Country:US
Practice Address - Phone:786-487-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier