Healthcare Provider Details

I. General information

NPI: 1841528643
Provider Name (Legal Business Name): TABITHA L HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABITHA SMITH APRN

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN STREET 3RD FL, SUITE C&D
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7394
  • Fax: 413-794-7136
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4203
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2323614
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: