Provider Demographics
NPI:1023640802
Name:SUTHERLAND MARBUTT, TABATHA MICHELLE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:MICHELLE
Last Name:SUTHERLAND MARBUTT
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:TABATHA
Other - Middle Name:MICHELLE
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15155 HIGHWAY 43 STE I
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1975
Mailing Address - Country:US
Mailing Address - Phone:256-331-2700
Mailing Address - Fax:
Practice Address - Street 1:15155 HIGHWAY 43 STE I
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1975
Practice Address - Country:US
Practice Address - Phone:256-331-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily