Provider Demographics
NPI:1982038790
Name:TIBBS, MELISSA ANN (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TIBBS
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 1:8850 TWINCREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4044
Mailing Address - Country:US
Mailing Address - Phone:937-701-1306
Mailing Address - Fax:
Practice Address - Street 1:8850 TWINCREEK DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-4044
Practice Address - Country:US
Practice Address - Phone:937-701-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.384935163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse