Healthcare Provider Details

I. General information

NPI: 1790462687
Provider Name (Legal Business Name): TABETHA BUZBEE APRN-RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/06/2024
Certification Date: 07/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

V. Phone/Fax

Practice location:
  • Phone: 937-305-0852
  • Fax:
Mailing address:
  • Phone: 937-305-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberAPRN-RNP
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number293880
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: