Provider Demographics
NPI:1205350980
Name:IMONDI, TABITHA ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:IMONDI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2939
Mailing Address - Country:US
Mailing Address - Phone:401-829-6788
Mailing Address - Fax:
Practice Address - Street 1:1525 OLD LOUISQUISSET PIKE STE 203
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4503
Practice Address - Country:US
Practice Address - Phone:774-291-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health