Provider Demographics
NPI:1477955045
Name:MIDDLETON, TAMBRA SHIVER (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:SHIVER
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1276
Mailing Address - Country:US
Mailing Address - Phone:251-990-1922
Mailing Address - Fax:251-990-1912
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-990-1922
Practice Address - Fax:251-990-1912
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily