Provider Demographics
NPI:1578302709
Name:TIBBS, PHILLIP SCOTT
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SCOTT
Last Name:TIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4415
Mailing Address - Country:US
Mailing Address - Phone:310-498-0228
Mailing Address - Fax:
Practice Address - Street 1:14 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-4415
Practice Address - Country:US
Practice Address - Phone:310-498-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant