Provider Demographics
NPI:1366247983
Name:JIBA, TABITHA S
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:S
Last Name:JIBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5183
Mailing Address - Country:US
Mailing Address - Phone:402-595-0231
Mailing Address - Fax:
Practice Address - Street 1:550 S JOHNSON RD APT 531
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-6530
Practice Address - Country:US
Practice Address - Phone:385-274-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty