Provider Demographics
NPI:1629578083
Name:BRUINSMA, TABITHA ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:ELIZABETH
Last Name:BRUINSMA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 UNDERWOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-841-2800
Mailing Address - Fax:321-843-8777
Practice Address - Street 1:76 UNDERWOOD ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:218-412-8003
Practice Address - Fax:321-843-8777
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9284474363LF0000X
FLAPRN9284474363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9284474OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH