MEDICARE: TABITHA BURNS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	56618	NM

General Provider Information

NPI Number	:	1649832619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA BURNS CNP

Provider Business Mailing Address
First Line	:	106 MONTE ALTO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-8864
Country	:	US
Telephone Number	:	575-644-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 PETROGLYPH CIR STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-1001
Country	:	US
Telephone Number	:	575-644-9521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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Directions to “ TABITHA BURNS CNP” Practice Location

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