Healthcare Provider Details

I. General information

NPI: 1295523892
Provider Name (Legal Business Name): TABITHA A. HALE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPRINGSIDE DR STE 350C
FAIRLAWN OH
44333-4536
US

IV. Provider business mailing address

150 SPRINGSIDE DR STE 350C
FAIRLAWN OH
44333-4536
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax:
Mailing address:
  • Phone: 832-869-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: