=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396004321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TABITHA ZAPPONE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2012
-----------------------------------------------------
Last Update Date | 11/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 B. TALISMAN DR. #3
-----------------------------------------------------
City | PAGOSA SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-731-5252
-----------------------------------------------------
Fax | 970-731-9922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 B TALISMAN DR. #3
-----------------------------------------------------
City | PAGOSA SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-731-5252
-----------------------------------------------------
Fax | 970-731-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0990376-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP-990376
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------