Provider Demographics
NPI:1548441496
Name:TIBBALS, CAROL J (WHCNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:TIBBALS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-662-6060
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-288-4048
Practice Address - Fax:804-288-3567
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2011-06-10
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Provider Licenses
StateLicense IDTaxonomies
VA0024000056363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology