Healthcare Provider Details

I. General information

NPI: 1548441496
Provider Name (Legal Business Name): CAROL J TIBBALS WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE SUITE 200
RICHMOND VA
23229-4946
US

IV. Provider business mailing address

7130 GLEN FOREST DR SUITE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4048
  • Fax: 804-288-3567
Mailing address:
  • Phone: 804-662-6060
  • Fax: 804-282-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024000056
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: