Provider Demographics
NPI:1043073687
Name:TIBBITTS, TRISHA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:TIBBITTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 ROTARY PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-9076
Mailing Address - Country:US
Mailing Address - Phone:641-481-8711
Mailing Address - Fax:
Practice Address - Street 1:101 CEDAR RIVER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-1010
Practice Address - Country:US
Practice Address - Phone:319-352-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA177956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily