1285915801 NPI number — TABITHA GENNARA APRN

Table of content: TABITHA GENNARA APRN (NPI 1285915801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285915801 NPI number — TABITHA GENNARA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENNARA
Provider First Name:
TABITHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLBATH
Provider Other First Name:
TABITHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285915801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14502 N DALE MABRY HWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33618-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-592-4275
Provider Business Mailing Address Fax Number:
813-550-1157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14502 N DALE MABRY HWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33618-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-592-4275
Provider Business Practice Location Address Fax Number:
813-550-1157
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APRN9249781 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN9249781 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5941163 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y09PW . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4937168 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 113043000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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