Provider Demographics
NPI:1578801486
Name:TIBBITTS, PATRICIA M
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:TIBBITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:JOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1000 CRESO RD
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8990
Mailing Address - Country:US
Mailing Address - Phone:253-539-7022
Mailing Address - Fax:
Practice Address - Street 1:12801 86TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5454
Practice Address - Country:US
Practice Address - Phone:253-840-8968
Practice Address - Fax:253-840-8802
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00083399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00083399OtherRN LICENSE