Provider Demographics
NPI:1497164768
Name:ORAVETZ, TABITHA ANN (DNP)
Entity Type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:ANN
Last Name:ORAVETZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:ANN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-880-9696
Practice Address - Fax:904-390-7452
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9169915363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily