Provider Demographics
NPI:1881097475
Name:BINGHAM, TABER (FNP-C)
Entity type:Individual
Prefix:
First Name:TABER
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TABER
Other - Middle Name:
Other - Last Name:BURLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 N ALVERNON WAY STE 251
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1879
Mailing Address - Country:US
Mailing Address - Phone:520-721-8605
Mailing Address - Fax:
Practice Address - Street 1:630 N ALVERNON WAY STE 251
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1879
Practice Address - Country:US
Practice Address - Phone:520-721-8605
Practice Address - Fax:520-721-4209
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7349363LF0000X, 363LX0001X
AZTAP7349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily