Provider Demographics
NPI:1033434840
Name:TUBERVILLE, DEBORAH H (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:TUBERVILLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3011
Mailing Address - Country:US
Mailing Address - Phone:901-369-4900
Mailing Address - Fax:901-365-3555
Practice Address - Street 1:3055 WATSON ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3011
Practice Address - Country:US
Practice Address - Phone:901-369-4900
Practice Address - Fax:901-365-3555
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily