Provider Demographics
NPI:1720657729
Name:SCHILLY, TABITHA FLOYD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:FLOYD
Last Name:SCHILLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 RUIN CREEK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5921
Mailing Address - Country:US
Mailing Address - Phone:252-436-1080
Mailing Address - Fax:
Practice Address - Street 1:568 RUIN CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5921
Practice Address - Country:US
Practice Address - Phone:252-436-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily