Individual
AMANDA MAE TIBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
83 HERRICK ST STE 2004, BEVERLY, MA 01915-2757
(978) 927-4800
(978) 777-4792
Mailing address
83 HERRICK ST STE 2004, BEVERLY, MA 01915-2757
(978) 927-4800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA7714
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1173579
NCCPA CERTIFICATION
MA
01
—
PA7714
PHYSICIAN ASSISTANT PRACTICING LICENSE
MA
Enumeration date
08/17/2020
Last updated
12/29/2023
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