Provider Demographics
NPI:1952621690
Name:NEWBORN, TABITHA LANEE (ARNP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LANEE
Last Name:NEWBORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 SW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0032
Mailing Address - Country:US
Mailing Address - Phone:352-204-5800
Mailing Address - Fax:352-451-4445
Practice Address - Street 1:150 SE 17TH ST STE 501
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5176
Practice Address - Country:US
Practice Address - Phone:352-204-5800
Practice Address - Fax:352-451-4445
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9283760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y04JPOtherBCBS FL
9448557OtherAETNA
FLDG395XMedicare PIN
9448557OtherAETNA
Y04JPOtherBCBS FL