Provider Demographics
NPI:1427248731
Name:ANDERSON, TABATHA P (RN,MSN,FNPC)
Entity type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN,MSN,FNPC
Other - Prefix:MISS
Other - First Name:TABATHA
Other - Middle Name:D
Other - Last Name:PEAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 SUNNY BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-4197
Mailing Address - Country:US
Mailing Address - Phone:706-988-0584
Mailing Address - Fax:
Practice Address - Street 1:590 HISTORIC HWY 441 N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149791363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care