Provider Demographics
NPI:1932811551
Name:DENNARD, TABITHA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:DENNARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8732 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2517
Mailing Address - Country:US
Mailing Address - Phone:410-251-1343
Mailing Address - Fax:
Practice Address - Street 1:715 E KING ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3505
Practice Address - Country:US
Practice Address - Phone:302-628-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197155363LA2200X, 363LG0600X
DELP-0010626363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health