MEDICARE: TABITHA COLLINS PHLEBOTOMIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1316669831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA COLLINS PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	2121 E FLAMINGO RD STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5124
Country	:	US
Telephone Number	:	702-659-7172
Fax Number	:	702-659-7172

Provider Business Practice Location Address
First Line	:	2295 E SAHARA AVE STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4113
Country	:	US
Telephone Number	:	702-659-7172
Fax Number	:	702-659-7172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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