Provider Demographics
NPI:1508323874
Name:SEPPALA, TABATHA L (ND)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:L
Last Name:SEPPALA
Suffix:
Gender:
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODWARD LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3103
Mailing Address - Country:US
Mailing Address - Phone:386-359-7044
Mailing Address - Fax:
Practice Address - Street 1:712 S OCEAN SHORE BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3602
Practice Address - Country:US
Practice Address - Phone:386-359-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224900000X, 372600000X, 374J00000X
172V00000X, 1744P3200X, 174H00000X, 174N00000X, 171400000X, 171M00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No372600000XNursing Service Related ProvidersAdult Companion
No172V00000XOther Service ProvidersCommunity Health Worker
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374J00000XNursing Service Related ProvidersDoula