Provider Demographics
NPI: | 1841918901 |
---|---|
Name: | SEMACH, TABITHA ROSE (FNP, PMHNP) |
Entity type: | Individual |
Prefix: | MRS |
First Name: | TABITHA |
Middle Name: | ROSE |
Last Name: | SEMACH |
Suffix: | |
Gender: | F |
Credentials: | FNP, PMHNP |
Other - Prefix: | |
Other - First Name: | TABITHA |
Other - Middle Name: | ROSE |
Other - Last Name: | JEE |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | FNP, PMHNP |
Mailing Address - Street 1: | 9523 W 77TH PL |
Mailing Address - Street 2: | |
Mailing Address - City: | ARVADA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80005-4035 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-218-6613 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3989 E ARAPAHOE RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | CENTENNIAL |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80122 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-379-7243 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-08-16 |
Last Update Date: | 2024-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | APN.0997997-NP | 363LP0808X |
TN | F12200017 | 363LF0000X |
CO | 2022066864 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |