Provider Demographics
NPI:1851068969
Name:WILLIBEY, TANA
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:WILLIBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 VALLEY POINT PL APT 1536
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-2256
Mailing Address - Country:US
Mailing Address - Phone:260-624-5799
Mailing Address - Fax:
Practice Address - Street 1:2231 VALLEY POINT PL APT 1536
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-2256
Practice Address - Country:US
Practice Address - Phone:260-624-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28252242A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology