Provider Demographics
NPI:1578734166
Name:BOND, TABITHA S (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:S
Last Name:BOND
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5709
Mailing Address - Country:US
Mailing Address - Phone:228-872-2403
Mailing Address - Fax:228-875-7584
Practice Address - Street 1:11 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5709
Practice Address - Country:US
Practice Address - Phone:228-872-2403
Practice Address - Fax:228-875-7584
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00289304Medicaid