Provider Demographics
NPI:1457722142
Name:PENA, TABITHA DAWN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:DAWN
Last Name:PENA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:TABITHA
Other - Middle Name:DAWN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:844-397-1311
Practice Address - Street 1:120 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2304
Practice Address - Country:US
Practice Address - Phone:812-524-8388
Practice Address - Fax:812-954-5021
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28180971A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily