Healthcare Provider Details

I. General information

NPI: 1437733292
Provider Name (Legal Business Name): THAIS A TIBBETTS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THAIS A GOMES

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 06/03/2023
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TER HEUN DR
FALMOUTH MA
02540-2503
US

IV. Provider business mailing address

297 NORTH ST STE 221
HYANNIS MA
02601-5133
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-5300
  • Fax:
Mailing address:
  • Phone: 508-862-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2281299
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN2281299
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: