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General NPI Number Information
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NPI Number | 1841647567
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Entity Type | Individual
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Provider Name | JONATHAN TIBALDO FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 20320 NORTHWEST FWY STE 400A
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City | JERSEY VILLAGE
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State | TX
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Zip | 77065-5620
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Country | US
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Telephone | 346-345-2092
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Fax | 281-883-4395
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Provider Business Mailing Address
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Address Line | PO BOX 39077
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City | BELFAST
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State | ME
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Zip | 04915-1232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP131029
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP131029
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License Number State | TX
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