Provider Demographics
NPI:1396495131
Name:ECKERT, TABITHA LOUISE (MD)
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:LOUISE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 TWISTED OAK LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9255
Mailing Address - Country:US
Mailing Address - Phone:717-695-1213
Mailing Address - Fax:
Practice Address - Street 1:1401 CENTERVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4638
Practice Address - Country:US
Practice Address - Phone:717-695-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program