Provider Demographics
NPI:1720862634
Name:TIBBITTS, COLLIN SCOTT (RN)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:SCOTT
Last Name:TIBBITTS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41274 N CAMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-3173
Mailing Address - Country:US
Mailing Address - Phone:801-436-4517
Mailing Address - Fax:
Practice Address - Street 1:41274 N CAMBRIA DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-3173
Practice Address - Country:US
Practice Address - Phone:801-436-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ249773163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine