Provider Demographics
NPI:1093241663
Name:LUBATON, AMABEL TANGUNAN (ARNP)
Entity Type:Individual
Prefix:
First Name:AMABEL
Middle Name:TANGUNAN
Last Name:LUBATON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 STATE ROAD 436 STE 224
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4965
Mailing Address - Country:US
Mailing Address - Phone:786-449-5448
Mailing Address - Fax:
Practice Address - Street 1:430 STATE ROAD 436 STE 224
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4965
Practice Address - Country:US
Practice Address - Phone:786-449-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9261848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily