Provider Demographics
NPI:1285915801
Name:GENNARA, TABITHA (APRN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:GENNARA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:COLBATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14502 N DALE MABRY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2040
Mailing Address - Country:US
Mailing Address - Phone:813-592-4275
Mailing Address - Fax:
Practice Address - Street 1:14502 N DALE MABRY HWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2040
Practice Address - Country:US
Practice Address - Phone:813-699-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9249781363LF0000X
FLARPN9249781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004146200Medicaid
FLFS953ZOtherMEDICARE PTAN
FLY09PWOtherBCBS