Provider Demographics
NPI:1811558042
Name:ABRAHAM, TABITHA ELISE (FNP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:ELISE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BIRDSALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3120
Mailing Address - Country:US
Mailing Address - Phone:805-863-3617
Mailing Address - Fax:
Practice Address - Street 1:1419 BIRDSALL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3120
Practice Address - Country:US
Practice Address - Phone:805-863-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily