Provider Demographics
NPI:1750149787
Name:REYES, TABBITHA (LPN)
Entity type:Individual
Prefix:
First Name:TABBITHA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TABBITHA
Other - Middle Name:
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 SIERRA PL S
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-4611
Mailing Address - Country:US
Mailing Address - Phone:505-414-6053
Mailing Address - Fax:
Practice Address - Street 1:2100 YUCCA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5498
Practice Address - Country:US
Practice Address - Phone:505-467-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57192164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse