Provider Demographics
NPI:1063701225
Name:CARNEVALE, TABITHA (RN, BSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:RN, BSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18031 MAYERLING ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 ROLLING OAKS DR STE 106
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1012
Practice Address - Country:US
Practice Address - Phone:805-494-4600
Practice Address - Fax:805-222-1887
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8132363L00000X
CA470589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner