Provider Demographics
NPI:1861114720
Name:MERRIMAN, TABATHA
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 RIDGE OAK LN APT 2112
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2902
Mailing Address - Country:US
Mailing Address - Phone:214-245-7636
Mailing Address - Fax:
Practice Address - Street 1:2511 RIDGE OAK LN APT 2112
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-2902
Practice Address - Country:US
Practice Address - Phone:214-245-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle