Healthcare Provider Details

I. General information

NPI: 1982882890
Provider Name (Legal Business Name): ROSEANN TIBBS RN/CNM/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BISHOP ST STE 240/310
SAN LUIS OBISPO CA
93401-4635
US

IV. Provider business mailing address

150 TEJAS PL PO BOX 430
NIPOMO CA
93444-9123
US

V. Phone/Fax

Practice location:
  • Phone: 805-549-0402
  • Fax:
Mailing address:
  • Phone: 805-929-3211
  • Fax: 805-929-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number31947/8301/1494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM1494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: