Provider Demographics
NPI:1861881419
Name:TIBBS-WHITE, SHAWRIKA (LPN)
Entity type:Individual
Prefix:
First Name:SHAWRIKA
Middle Name:
Last Name:TIBBS-WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 BONNY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3538
Mailing Address - Country:US
Mailing Address - Phone:423-208-0394
Mailing Address - Fax:
Practice Address - Street 1:6315 BONNY OAKS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3538
Practice Address - Country:US
Practice Address - Phone:423-208-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN057606251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health