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General NPI Number Information
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NPI Number | 1992350854
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Entity Type | Individual
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Provider Name | NICOLE C TABBAL AGACNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 25030 SW PARKWAY AVE STE 200
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City | WILSONVILLE
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State | OR
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Zip | 97070-9816
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Country | US
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Telephone | 971-434-0080
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Fax | 503-946-3891
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Provider Business Mailing Address
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Address Line | 25030 SW PARKWAY AVE STE 200
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City | WILSONVILLE
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State | OR
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Zip | 97070-9816
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Country | US
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Telephone | 971-434-0080
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Fax | 503-946-3891
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 201906846NP-PP
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 201906846NP-PP
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License Number State | OR
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