Healthcare Provider Details

I. General information

NPI: 1215852777
Provider Name (Legal Business Name): TABITHA MAE BOHREN RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABITHA HERBERT, POLLY RN

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S KITSAP BLVD STE 210
PORT ORCHARD WA
98366-3738
US

IV. Provider business mailing address

11567 CANTERWOOD BLVD
GIG HARBOR WA
98332-5812
US

V. Phone/Fax

Practice location:
  • Phone: 608-958-9000
  • Fax:
Mailing address:
  • Phone: 253-530-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70177725-NP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60215894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: