Healthcare Provider Details

I. General information

NPI: 1699404954
Provider Name (Legal Business Name): RYLEIGH C TIBBITT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PELHAM RD N
JACKSONVILLE AL
36265-1602
US

IV. Provider business mailing address

700 PELHAM RD N
JACKSONVILLE AL
36265-1602
US

V. Phone/Fax

Practice location:
  • Phone: 256-782-5781
  • Fax:
Mailing address:
  • Phone: 256-782-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-176904
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: