Provider Demographics
NPI:1871648196
Name:TIBBETTS, NANCY M (CNM, F-NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:CNM, F-NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 115
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-477-3119
Practice Address - Fax:530-274-2077
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANMW958367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife