Provider Demographics
NPI:1114539137
Name:TUBBS, BROOKE MARISSA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARISSA
Last Name:TUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 REDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-9602
Mailing Address - Country:US
Mailing Address - Phone:989-513-9360
Mailing Address - Fax:
Practice Address - Street 1:5135 REDSTONE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-9602
Practice Address - Country:US
Practice Address - Phone:989-513-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program