Provider Demographics
NPI:1881967271
Name:TEBBE, JOYCE ANN (ACNP)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ANN
Last Name:TEBBE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MOTE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-1260
Mailing Address - Country:US
Mailing Address - Phone:937-473-3025
Mailing Address - Fax:937-473-3196
Practice Address - Street 1:2600 MOTE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-1260
Practice Address - Country:US
Practice Address - Phone:937-473-3025
Practice Address - Fax:937-473-3196
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13008-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067404Medicaid
OH0067404Medicaid
OHH091524Medicare PIN