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NPI Code Detail

MEDICARE: TABITHA K NIETO

MEDICARE: TABITHA K NIETO
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
1104100000XSocial Worker
21041C0700XClinical Social WorkerSW14707FL

General Provider Information

NPI Number : 1982017604
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABITHA K NIETO
Provider Business Mailing Address
First Line : 403 E 11TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-3409
Country : US
Telephone Number : 850-767-3350
Fax Number :
Provider Business Practice Location Address
First Line : 2235 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-6023
Country : US
Telephone Number : 850-747-5272
Fax Number : 850-747-5274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 10/15/2025

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Directions to “ TABITHA K NIETO ” Practice Location

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