Healthcare Provider Details

I. General information

NPI: 1881097475
Provider Name (Legal Business Name): TABER BINGHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TABER BURLESON

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N ALVERNON WAY STE 251
TUCSON AZ
85711-1879
US

IV. Provider business mailing address

630 N ALVERNON WAY STE 251
TUCSON AZ
85711-1879
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-8605
  • Fax: 520-721-4209
Mailing address:
  • Phone: 520-721-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7349
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP7349
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP7349
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: