Provider Demographics
NPI:1801480959
Name:CANTRELL, TABITHA SAMARA (RN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:SAMARA
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 W RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3103
Mailing Address - Country:US
Mailing Address - Phone:423-763-7377
Mailing Address - Fax:
Practice Address - Street 1:3935 W RD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3103
Practice Address - Country:US
Practice Address - Phone:423-763-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN205482163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse