Provider Demographics
NPI:1649536863
Name:TARBUSH, CLARA L
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:L
Last Name:TARBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:L
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1131 MUDDY FORD RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7862
Practice Address - Country:US
Practice Address - Phone:803-312-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62318163WC0200X
SC18081367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN2243Medicaid
SCGP2825Medicaid
SC007OtherBLUECHOICE
SC009OtherBCBS