Provider Demographics
NPI:1982428272
Name:TIBBEN, JENNIFER (AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:TIBBEN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:YACHANIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP
Mailing Address - Street 1:PO BOX 22392
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-0392
Mailing Address - Country:US
Mailing Address - Phone:520-820-7918
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 22392
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37933-0392
Practice Address - Country:US
Practice Address - Phone:520-820-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37499363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner